Provider Demographics
NPI:1457471419
Name:AMPAJWALA, MADHAVI (MD)
Entity Type:Individual
Prefix:
First Name:MADHAVI
Middle Name:
Last Name:AMPAJWALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9990 DALLAS PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-4133
Mailing Address - Country:US
Mailing Address - Phone:214-387-8288
Mailing Address - Fax:214-387-8289
Practice Address - Street 1:9990 DALLAS PKWY STE 200
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-4133
Practice Address - Country:US
Practice Address - Phone:214-387-8288
Practice Address - Fax:143-878-2892
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH13735207Q00000X
TXM8491207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine