Provider Demographics
NPI:1538377478
Name:ROY, KAUSIK (MD)
Entity type:Individual
Prefix:
First Name:KAUSIK
Middle Name:
Last Name:ROY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26726
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78755-0726
Mailing Address - Country:US
Mailing Address - Phone:512-407-8686
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:1401 MEDICAL PKWY, BLDG B #220
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7464
Practice Address - Country:US
Practice Address - Phone:512-260-1581
Practice Address - Fax:512-528-7923
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57010379207R00000X
TXN5983207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX214191301Medicaid
TX214191302Medicaid
TX214191303Medicaid
TX315099YLP2Medicare PIN
TXTXB107467Medicare PIN
TX214191303Medicaid
TX315099YLP1Medicare PIN