Provider Demographics
NPI:1659056968
Name:SP OBGYN ,PLLC
Entity Type:Organization
Organization Name:SP OBGYN ,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SRIDEVI
Authorized Official - Middle Name:
Authorized Official - Last Name:PANCHAMUKHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-201-0632
Mailing Address - Street 1:6863 ELDARICA PL
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-8352
Mailing Address - Country:US
Mailing Address - Phone:618-201-0632
Mailing Address - Fax:
Practice Address - Street 1:6863 ELDARICA PL
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-8352
Practice Address - Country:US
Practice Address - Phone:618-201-0632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-15
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty