Provider Demographics
NPI:1235463993
Name:KANAKADURGA GOVINDARAJU, MD, PLLC
Entity Type:Organization
Organization Name:KANAKADURGA GOVINDARAJU, MD, PLLC
Other - Org Name:KYLE FAMILY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KANAKADURGA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOVINDARAJU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-268-2929
Mailing Address - Street 1:147 ELMHURST
Mailing Address - Street 2:STE 200
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-6119
Mailing Address - Country:US
Mailing Address - Phone:512-268-2929
Mailing Address - Fax:512-268-2930
Practice Address - Street 1:147 ELMHURST
Practice Address - Street 2:STE 200
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-6119
Practice Address - Country:US
Practice Address - Phone:512-268-2929
Practice Address - Fax:512-268-2930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-29
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3318207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty