Provider Demographics
NPI:1659684504
Name:UNIVERSAL PHYSICIAN AND TELEMEDICINE PLLC
Entity Type:Organization
Organization Name:UNIVERSAL PHYSICIAN AND TELEMEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANURAG
Authorized Official - Middle Name:
Authorized Official - Last Name:MISHRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:620-390-9173
Mailing Address - Street 1:6800 SMOKETREE TRL
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76208-7372
Mailing Address - Country:US
Mailing Address - Phone:630-847-8384
Mailing Address - Fax:877-334-1352
Practice Address - Street 1:6800 SMOKETREE TRL
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76208-7372
Practice Address - Country:US
Practice Address - Phone:630-847-8384
Practice Address - Fax:877-334-1352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-21
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X, 207RC0000X
KS0425612207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty