Provider Demographics
NPI:1013270206
Name:ANURADHA KANTAMANI, MD PA
Entity Type:Organization
Organization Name:ANURADHA KANTAMANI, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANURADHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KANTAMANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-398-5863
Mailing Address - Street 1:701 S FRY RD
Mailing Address - Street 2:STE 105
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-2243
Mailing Address - Country:US
Mailing Address - Phone:281-398-5863
Mailing Address - Fax:281-398-1430
Practice Address - Street 1:701 S FRY RD
Practice Address - Street 2:STE 105
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2243
Practice Address - Country:US
Practice Address - Phone:281-398-5863
Practice Address - Fax:281-398-1430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-21
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4097207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3322901-01Medicaid
TXTXB158076OtherMEDICARE PTAN