Basic Information
| Provider Information | |||||||||
| NPI: | 1407119464 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOVOOR | ||||||||
| FirstName: | ANDREW | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 911230 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753911230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729978000 | ||||||||
| FaxNumber: | 9722340813 | ||||||||
| Practice Location | |||||||||
| Address1: | 4708 ALLIANCE BLVD STE 150 | ||||||||
| Address2: | |||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75093 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9725967801 | ||||||||
| FaxNumber: | 9725969307 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2012 | ||||||||
| LastUpdateDate: | 09/17/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | R5884 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 390200000X | R73264 | AZ | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
ID Information
| ID | Type | State | Issuer | Description | 384656002 | 05 | TX | MEDICAID | 384656001 | 05 | TX | MEDICAID |