Provider Demographics
NPI:1861490955
Name:TAMIRISA, KAMALA P (MD)
Entity Type:Individual
Prefix:DR
First Name:KAMALA
Middle Name:P
Last Name:TAMIRISA
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 1:11970 N CENTRAL EXPY STE 540
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3768
Mailing Address - Country:US
Mailing Address - Phone:972-566-4822
Mailing Address - Fax:
Practice Address - Street 1:11970 N CENTRAL EXPY STE 540
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3768
Practice Address - Country:US
Practice Address - Phone:972-566-4822
Practice Address - Fax:972-566-4170
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35087019207RC0001X
OH35.087019207RC0000X
MI4301077376207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2621130Medicaid
P00751115OtherRRMC
MIMI1635012Medicaid
OH4176321Medicare PIN
OH4176324Medicare PIN
OH2621130Medicaid
OH4176319Medicare PIN
MIMI1635012Medicaid
OH4176315Medicare PIN
OH4176317Medicare PIN
OHTA4176325Medicare PIN
OH4176314Medicare PIN
OH4176316Medicare PIN
OH4176323Medicare PIN
OH4176311Medicare PIN