Provider Demographics
NPI:1336466150
Name:PADMAJA AKKINENI MD PA
Entity Type:Organization
Organization Name:PADMAJA AKKINENI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PADMAJA
Authorized Official - Middle Name:
Authorized Official - Last Name:AKKINENI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-791-8225
Mailing Address - Street 1:7612 MEMPHIS DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3988
Mailing Address - Country:US
Mailing Address - Phone:214-862-2978
Mailing Address - Fax:972-767-3232
Practice Address - Street 1:5757 WARREN PKWY
Practice Address - Street 2:SUITE# 208
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4274
Practice Address - Country:US
Practice Address - Phone:972-791-8225
Practice Address - Fax:972-767-3232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-04
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1457207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2831976-01Medicaid
TX2831976-01Medicaid