Provider Demographics
NPI:1790065464
Name:RAGHAVAPURAM, SAIKIRAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SAIKIRAN
Middle Name:
Last Name:RAGHAVAPURAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8267 ELMBROOK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4078
Mailing Address - Country:US
Mailing Address - Phone:214-424-2200
Mailing Address - Fax:214-231-2159
Practice Address - Street 1:11330 LEGACY DR STE 205
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-1218
Practice Address - Country:US
Practice Address - Phone:469-535-5070
Practice Address - Fax:214-436-4798
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036142929207R00000X
ARE-8427207R00000X, 207RG0100X
390200000X
TXT5005207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program