DR. KISHOR MALLIKARJUN BHENDE (NPI# 1336304716) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336304716 |
| Entity Type | Individual |
| Full Name | DR. KISHOR MALLIKARJUN BHENDE |
| Credential | MD |
| Practice Address |
602 Indiana Ave Swcc Lubbock TX 79415-3364 |
| Mailing Address |
Po Box 5865 Lubbock TX 79408-5865 |
| Practice Telephone | 8067758600 |
| Practice Fax Number | 8067758602 |
| Mailing Telephone | 8067432898 |
| Mailing Fax Number | 8067432787 |
| Enumeration Date | 2008-07-24 |
| Last Update Date | 2018-10-24 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208000000X | Pediatrics | Q6496 | TX | Allopathic & Osteopathic Physicians |
| Y | 2080P0207X |
Pediatrics Specialization: Pediatric Hematology-Oncology |
Q6496 | TX | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | 813355 | 05 |
| Street Address |
602 INDIANA AVE SWCC |
| City | LUBBOCK |
| State | TX |
| Zip Code | 79415-3364 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487659876 | Mark Brendan Reedy | Obstetrics & Gynecology | 602 Indiana Ave, Lubbock, TX 79415-3364 | 2005-06-14 |
| 1417571613 | Chelsea Brooke Seaton | Student in an Organized Health Care Education/Training Program | 602 Indiana Ave, Lubbock, TX 79415-3364 | 2020-06-03 |
| 1437773728 | John Clinton Fisher IIi | Student in an Organized Health Care Education/Training Program | 602 Indiana Ave, Lubbock, TX 79415-3364 | 2020-06-02 |
| 1700409448 | Ryan Everett Hirata | Student in an Organized Health Care Education/Training Program | 602 Indiana Ave, Lubbock, TX 79415-3364 | 2020-05-28 |
| 1013530716 | Lillian Amezquita | Student in an Organized Health Care Education/Training Program | 602 Indiana Ave, Lubbock, TX 79415-3364 | 2020-05-28 |
| 1457990186 | Madison Dreu Williams | Registered Nurse | 602 Indiana Ave, Lubbock, TX 79415-3364 | 2019-12-28 |
| 1972145977 | Alicia Garcia Castanon | Nurse Practitioner | 602 Indiana Ave, Lubbock, TX 79415-3364 | 2019-10-10 |
| 1770133746 | Candace Kernell | Registered Nurse | 602 Indiana Ave, Lubbock, TX 79415-3364 | 2019-09-12 |
| 1154883767 | James William Woodwick Jr. | Nurse Practitioner | 602 Indiana Ave, Lubbock, TX 79415-3364 | 2019-04-02 |
| 1811455066 | Rolando Adolfo Lugo II | Nurse Practitioner | 602 Indiana Ave, Lubbock, TX 79415-3364 | 2019-03-06 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831569540 | Community Health Center of Lubbock, Inc. | Clinic/Center | 3502 9th St Ste 280, Lubbock, TX 79415 | 2015-10-07 |
| 1922447457 | Fnu Parijat Kumar | Physical Therapist | 2717 3rd Street, Aptt 803, Lubbock, TX 79415 | 2013-06-18 |
| 1851575906 | Diego Rivera, M.d., P.a. | Family Medicine | 111 University Ave, Lubbock, TX 79415 | 2007-12-26 |
| 1730206632 | Kathleen Brinkman Felts | Physical Therapist | 3710 4th Street, Lubbock, TX 79415 | 2007-03-23 |
| 1568508521 | Horace Rueben Sharp Jr. | Optometrist | 1911 4th St, Lubbock, TX 79415 | 2007-01-29 |
| 1699876201 | Patricia R. Arledge | Plastic Surgery | 3502 9th St., Suite 270, Lubbock, TX 79415 | 2006-09-26 |
| 1245330018 | Perlita Molina Sambrano-tandoc | Nurse Practitioner | 602 East Indiana Avenue, Lubbock, TX 79415 | 2006-09-22 |
| 1639199862 | Justin Tidwell | Emergency Medicine | 604 Indiana, Lubbock, TX 79415 | 2006-07-20 |
| 1912944059 | Community Health Center of Lubbock, Inc. | Clinic/Center | 3301 Clovis Road, Lubbock, TX 79415 | 2006-05-31 |
| 1497709265 | Byron Wayne Schoettle | Radiology | 602 Indiana Avenue, Lubbock, TX 79415 | 2006-05-19 |
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| Taxonomy Code | 2080P0207X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Hematology-Oncology |
| A pediatrician trained in the combination of pediatrics, hematology and oncology to recognize and manage pediatric blood disorders and cancerous diseases. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) was provided by the American Osteopathic Board of Pediatrics. The Certification is no longer offered. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952523458 | Chibuzo C. O'suoji | Pediatrics | 602 Indiana Ave, Lubbock, TX 79415 | 2007-05-03 |
| 1013947043 | Latha Prasannan | Pediatrics | 4102 24th St, Ste 201, Lubbock, TX 79410-1806 | 2006-07-04 |
| 1033185608 | Ihsan Al-khalil | Pediatrics | 3601 4th St, Lubbock, TX 79430-0002 | 2006-02-24 |
| 1548241722 | Melanie G. Oblender | Pediatrics | 3615 19th St, W322, Lubbock, TX 79410-1203 | 2005-11-07 |
| 1578554184 | John Iacuone | Pediatrics | 6630 Quaker Ave, Suite I, Lubbock, TX 79413-5900 | 2005-11-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437577111 | Ayten Cangir I | Pediatrics | 10 Summer Prt, Spring, TX 77381-4270 | 2014-03-31 |
| 1356776116 | Piti Techavichit | Pediatrics | 6701 Fannin Street Suit 1510, Texas Children's Hospital, Clinical Care Center, Houston, TX 77030 | 2013-09-11 |
| 1982049219 | Elizabeth Lynn Seashore | Pediatrics | 1102 Bates Ave Ste C750.01, Houston, TX 77030-2617 | 2013-04-30 |
| 1386088490 | Anil Pazhayattil George | Pediatrics | 1102 Bates Ave Ste 1630, Houston, TX 77030-2632 | 2013-04-18 |
| 1629322789 | Rosa Diaz | Pediatrics | 7676 Phoenix Dr Apt 1427, Houston, TX 77030-4724 | 2012-10-28 |
| 1871842278 | Pamela E Camacho | Pediatrics | 17580 Interstate 45 S Ste 450, The Woodlands, TX 77384-4964 | 2012-08-31 |
| 1437418167 | Taylor Olmsted Kim | Pediatrics | 1102 Bates Ave Ste C1025.06, Houston, TX 77030 | 2012-05-15 |
| 1316237332 | Alicia K Chang | Pediatrics | 1102 Bates Ave Ste 1025.06, Houston, TX 77030 | 2011-04-11 |
| 1629399092 | Tami Denise John | Pediatrics | 1615 Hermann Dr Unit 2209, Houston, TX 77004-7152 | 2010-06-18 |
| 1700118171 | Ricardo J Flores | Pediatrics | 6621 Fannin St # Cc142000, Clinical Care Center, Houston, TX 77030-2303 | 2010-02-09 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.