Provider Demographics
NPI:1528030210
Name:KUNCHAM, SREEVANI (MD)
Entity Type:Individual
Prefix:DR
First Name:SREEVANI
Middle Name:
Last Name:KUNCHAM
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 1:131 DEGAN AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-3602
Mailing Address - Country:US
Mailing Address - Phone:972-436-7424
Mailing Address - Fax:972-219-0343
Practice Address - Street 1:131 DEGAN AVE STE 202
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-3602
Practice Address - Country:US
Practice Address - Phone:972-436-7424
Practice Address - Fax:972-219-0343
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5423207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D0211Medicare ID - Type Unspecified
TXI23151Medicare UPIN