Provider Demographics
NPI:1710429683
Name:NAGA MUMMANENI MD PLLC
Entity Type:Organization
Organization Name:NAGA MUMMANENI MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NAGAPRASADARAO
Authorized Official - Middle Name:
Authorized Official - Last Name:MUMMANENI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-425-8880
Mailing Address - Street 1:PO BOX 250794
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-0794
Mailing Address - Country:US
Mailing Address - Phone:972-668-7460
Mailing Address - Fax:972-474-3423
Practice Address - Street 1:4510 MEDICAL CENTER DR STE 150
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-0144
Practice Address - Country:US
Practice Address - Phone:972-668-7460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-09
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37672207L00000X
MI4301035894207L00000X
TXG4175207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty