Provider Demographics
NPI:1467608976
Name:KODALI, PREETI PRASAD (MD)
Entity Type:Individual
Prefix:
First Name:PREETI
Middle Name:PRASAD
Last Name:KODALI
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 1:7737 SOUTHWEST FWY STE 625
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1865
Mailing Address - Country:US
Mailing Address - Phone:713-456-5660
Mailing Address - Fax:
Practice Address - Street 1:7737 SOUTHWEST FWY STE 625
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1865
Practice Address - Country:US
Practice Address - Phone:713-456-5660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-15
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125053388207R00000X
TXN6430207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine