Individual
SANDEEP KODITYAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
18488 INTERSTATE 45 S, SHENANDOAH, TX 77384-4118
(281) 569-2100
Mailing address
22710 PROFESSIONAL DR STE 102, KINGWOOD, TX 77339-6009
(281) 358-2850
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
L6990
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
187751601
—
TX
Enumeration date
02/20/2007
Last updated
10/26/2018
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