Provider Demographics
NPI:1528056538
Name:GOYAL, SATISH K (MD)
Entity type:Individual
Prefix:
First Name:SATISH
Middle Name:K
Last Name:GOYAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2540 N GALLOWAY AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-6306
Mailing Address - Country:US
Mailing Address - Phone:972-613-4185
Mailing Address - Fax:972-613-4788
Practice Address - Street 1:2540 N GALLOWAY AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6306
Practice Address - Country:US
Practice Address - Phone:972-613-4185
Practice Address - Fax:972-613-4788
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7473207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0353682-01Medicaid
00PN14Medicare PIN
TX0353682-01Medicaid