Provider Demographics
NPI:1508242058
Name:SIVA P SONTINENI,MD,PA.
Entity Type:Organization
Organization Name:SIVA P SONTINENI,MD,PA.
Other - Org Name:RADIANT HEART & VASCULAR CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SIVA
Authorized Official - Middle Name:PRASAD
Authorized Official - Last Name:SONTINENI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-645-1155
Mailing Address - Street 1:PO BOX 293297
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75029-3297
Mailing Address - Country:US
Mailing Address - Phone:469-645-1155
Mailing Address - Fax:469-645-1210
Practice Address - Street 1:2701 SHORELINE DR STE 101
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-0175
Practice Address - Country:US
Practice Address - Phone:469-645-1155
Practice Address - Fax:469-645-1210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-07
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3514937Medicaid
TXDW0363OtherMEDICARE RAIL ROAD PTAN
TXDW0363OtherMEDICARE RAIL ROAD PTAN