Provider Demographics
NPI:1124010616
Name:ANNAMANENI, AMIT (MD)
Entity Type:Individual
Prefix:DR
First Name:AMIT
Middle Name:
Last Name:ANNAMANENI
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 1:845 FM 1960 RD W STE 103
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-3943
Mailing Address - Country:US
Mailing Address - Phone:281-440-8443
Mailing Address - Fax:281-440-8449
Practice Address - Street 1:845 FM 1960 RD W STE 103
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-3943
Practice Address - Country:US
Practice Address - Phone:281-440-8443
Practice Address - Fax:281-440-8449
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0609207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX101360903Medicaid
TX8537BOMedicare ID - Type Unspecified
TX101360903Medicaid