Provider Demographics
NPI:1649244054
Name:KANTAMANI, ANURADHA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANURADHA
Middle Name:
Last Name:KANTAMANI
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 1:701 S FRY RD
Mailing Address - Street 2:STE 105
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-2243
Mailing Address - Country:US
Mailing Address - Phone:281-398-5863
Mailing Address - Fax:281-398-1430
Practice Address - Street 1:701 S. FRY RD,
Practice Address - Street 2:STE 105
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2243
Practice Address - Country:US
Practice Address - Phone:281-398-5863
Practice Address - Fax:281-398-1430
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4097207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0308736-02Medicaid
TXTXB158076Medicare PIN
TX030873601Medicaid