Provider Demographics
NPI:1154672590
Name:AMITA HEGDE MD PLLC
Entity Type:Organization
Organization Name:AMITA HEGDE MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMITA
Authorized Official - Middle Name:
Authorized Official - Last Name:HEGDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-653-3609
Mailing Address - Street 1:7439 FIREOAK DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4539
Mailing Address - Country:US
Mailing Address - Phone:512-243-6588
Mailing Address - Fax:
Practice Address - Street 1:7439 FIREOAK DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4539
Practice Address - Country:US
Practice Address - Phone:512-243-6588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-25
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2312207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB165692Medicare PIN