Provider Demographics
NPI:1972707776
Name:GNANA S R NAINI , M.D, P.A
Entity Type:Organization
Organization Name:GNANA S R NAINI , M.D, P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GNANASUMATHI
Authorized Official - Middle Name:REDDY
Authorized Official - Last Name:NAINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-469-8749
Mailing Address - Street 1:3107 BLUFFS LN
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-6556
Mailing Address - Country:US
Mailing Address - Phone:972-422-0505
Mailing Address - Fax:972-516-3971
Practice Address - Street 1:1501 N PLANO RD
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-2492
Practice Address - Country:US
Practice Address - Phone:972-325-8060
Practice Address - Fax:972-516-3971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6902207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00W092Medicare PIN
TXE46321Medicare UPIN