Provider Demographics
NPI:1891824686
Name:KETHINENI, NIRMALA (MD)
Entity Type:Individual
Prefix:DR
First Name:NIRMALA
Middle Name:
Last Name:KETHINENI
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 1:7630 FRY RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-3375
Mailing Address - Country:US
Mailing Address - Phone:281-463-1400
Mailing Address - Fax:281-463-1432
Practice Address - Street 1:7630 FRY RD
Practice Address - Street 2:SUITE 300
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-3375
Practice Address - Country:US
Practice Address - Phone:281-463-1400
Practice Address - Fax:281-463-1432
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1430207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX199525002Medicaid
TX00Z744Medicare PIN