Basic Information
Provider Information
NPI: 1174561807
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KAMAT
FirstName: DEEPAK
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential: MD PHD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 87
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782910087
CountryCode: US
TelephoneNumber: 2103589500
FaxNumber: 2103589183
Practice Location
Address1: 903 W MARTIN ST
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 78207
CountryCode: US
TelephoneNumber: 2103585437
FaxNumber: 2103586880
Other Information
ProviderEnumerationDate: 06/03/2006
LastUpdateDate: 08/28/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000X4301081822MIN Allopathic & Osteopathic PhysiciansPediatrics 
208000000XS1143TXY Allopathic & Osteopathic PhysiciansPediatrics 

No ID Information.


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