Provider Demographics
NPI:1497930291
Name:AILNANI, SUPRIYA (MD)
Entity Type:Individual
Prefix:
First Name:SUPRIYA
Middle Name:
Last Name:AILNANI
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:PO BOX 26726
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78755-0726
Mailing Address - Country:US
Mailing Address - Phone:512-407-8686
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:1301 W 38TH ST
Practice Address - Street 2:#205
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1000
Practice Address - Country:US
Practice Address - Phone:512-324-1864
Practice Address - Fax:512-419-9016
Is Sole Proprietor?:No
Enumeration Date:2007-12-31
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN9996207R00000X
MA235352207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX286033004Medicaid
TX286033003Medicaid
TX286033001Medicaid
TX286033002Medicaid
TX286033001Medicaid
TXTXB155621Medicare PIN
TX286033003Medicaid
TXTXB136247Medicare PIN
TXTXB136243Medicare PIN
TXP01060075Medicare PIN