Provider Demographics
NPI:1023050812
Name:MADDALA, YAMINI K (MD)
Entity type:Individual
Prefix:DR
First Name:YAMINI
Middle Name:K
Last Name:MADDALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:7610 N STEMMONS FWY STE 600
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4228
Mailing Address - Country:US
Mailing Address - Phone:214-689-5960
Mailing Address - Fax:469-713-8084
Practice Address - Street 1:981 STATE HIGHWAY 121
Practice Address - Street 2:SUITE 1140
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013
Practice Address - Country:US
Practice Address - Phone:469-697-5100
Practice Address - Fax:469-697-5105
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4314207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX185054701Medicaid
TX8B4314OtherBCBSTX
TX8J3405Medicare PIN
TXH64399Medicare UPIN
TX8B4314OtherBCBSTX