Provider Demographics
NPI:1053506949
Name:THATISHETTY, AMEET VENKAT (MD)
Entity Type:Individual
Prefix:
First Name:AMEET
Middle Name:VENKAT
Last Name:THATISHETTY
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 1:6200 W PARKER RD
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8185
Mailing Address - Country:US
Mailing Address - Phone:972-981-3225
Mailing Address - Fax:972-981-3967
Practice Address - Street 1:6200 W PARKER RD
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8185
Practice Address - Country:US
Practice Address - Phone:972-981-3225
Practice Address - Fax:972-981-3967
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA061524207R00000X, 208M00000X
TXR5944207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
01343899OtherAMERIGROUP
GA398928354BMedicaid
GA398928354AMedicaid
GA473627OtherWELLCARE
SCG61524Medicaid
GAP00635639OtherRR MEDICARE
P00803285OtherRR MEDICARE
GAP00635639OtherRR MEDICARE
P00803285OtherRR MEDICARE