Provider Demographics
NPI:1851548622
Name:KAMINENI, SUCHITRA RAO (MD)
Entity Type:Individual
Prefix:
First Name:SUCHITRA
Middle Name:RAO
Last Name:KAMINENI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8795 PRESTON TRACE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-3010
Mailing Address - Country:US
Mailing Address - Phone:214-705-3728
Mailing Address - Fax:214-308-9464
Practice Address - Street 1:8795 PRESTON TRACE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-3010
Practice Address - Country:US
Practice Address - Phone:214-705-3728
Practice Address - Fax:214-308-9464
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-25
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301091547207R00000X
TXP0418207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX257480ZRVTMedicare PIN