Provider Demographics
NPI:1609015312
Name:BHEEMANENI, SIRISHA (MD)
Entity Type:Individual
Prefix:DR
First Name:SIRISHA
Middle Name:
Last Name:BHEEMANENI
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 1:9825 N MACARTHUR BLVD
Mailing Address - Street 2:APT 1205
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-7188
Mailing Address - Country:US
Mailing Address - Phone:903-707-1521
Mailing Address - Fax:
Practice Address - Street 1:11801 S FRWY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76115
Practice Address - Country:US
Practice Address - Phone:817-568-5955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-19
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP1050207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB146314Medicare PIN