Provider Demographics
NPI:1730476623
Name:DASARI, ANTHIA PHILPMINA (MD)
Entity Type:Individual
Prefix:
First Name:ANTHIA
Middle Name:PHILPMINA
Last Name:DASARI
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 1:4400 LONG PRAIRIE RD
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-1892
Mailing Address - Country:US
Mailing Address - Phone:469-322-7481
Mailing Address - Fax:469-322-7807
Practice Address - Street 1:4400 LONG PRAIRIE RD
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1892
Practice Address - Country:US
Practice Address - Phone:469-322-7481
Practice Address - Fax:469-322-7807
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301098277207R00000X
TXR3823207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine