Provider Demographics
NPI:1942583596
Name:PARASHURAMAPPA KONASAGAR, PRAVEEN (SA-C)
Entity Type:Individual
Prefix:
First Name:PRAVEEN
Middle Name:
Last Name:PARASHURAMAPPA KONASAGAR
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17424 W GRAND PKWY S STE 135
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2564
Mailing Address - Country:US
Mailing Address - Phone:713-562-6237
Mailing Address - Fax:832-449-3663
Practice Address - Street 1:17424 W GRAND PKWY S STE 135
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2564
Practice Address - Country:US
Practice Address - Phone:713-562-6237
Practice Address - Fax:832-449-3663
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10-294246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant