Provider Demographics
NPI:1003003609
Name:PAKKIVENKATA, UMA BRK (MD)
Entity Type:Individual
Prefix:
First Name:UMA
Middle Name:BRK
Last Name:PAKKIVENKATA
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 1:9900 N CENTRAL EXPY STE 215
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-0929
Mailing Address - Country:US
Mailing Address - Phone:214-396-4950
Mailing Address - Fax:877-423-5360
Practice Address - Street 1:9900 N CENTRAL EXPY STE 215
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-0929
Practice Address - Country:US
Practice Address - Phone:214-396-4950
Practice Address - Fax:877-423-5360
Is Sole Proprietor?:No
Enumeration Date:2007-09-27
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3969207R00000X, 207RN0300X
VA0101249410207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3127078Medicaid
TXTXB161220Medicare PIN