Provider Demographics
NPI:1114142403
Name:SONTINENI, SIVA PRASAD (MD)
Entity Type:Individual
Prefix:DR
First Name:SIVA
Middle Name:PRASAD
Last Name:SONTINENI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SIVA
Other - Middle Name:PRASAD
Other - Last Name:S.
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 293297
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75029-3297
Mailing Address - Country:US
Mailing Address - Phone:469-645-1155
Mailing Address - Fax:866-282-7202
Practice Address - Street 1:802 N BONNIE BRAE ST # 104
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-2499
Practice Address - Country:US
Practice Address - Phone:469-645-1155
Practice Address - Fax:469-645-1210
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP4112207RI0011X, 207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3514952Medicaid
TXP01542377OtherMEDICARE RAIL ROAD PTAN
TX325519ZQW9Medicare PIN