Provider Demographics
NPI:1457469108
Name:HALASWAMY, HANAGAVADI SIDDAVEERAPPA (MD)
Entity Type:Individual
Prefix:DR
First Name:HANAGAVADI
Middle Name:SIDDAVEERAPPA
Last Name:HALASWAMY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2075 SAVANNAH TRCE
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-2553
Mailing Address - Country:US
Mailing Address - Phone:409-898-7484
Mailing Address - Fax:409-813-1199
Practice Address - Street 1:3560 DELAWARE ST STE 601
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-3067
Practice Address - Country:US
Practice Address - Phone:409-924-9666
Practice Address - Fax:409-924-9696
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK5982207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH830037Medicare UPIN