Provider Demographics
NPI:1265513923
Name:ATLURI, SUMITHA (MD)
Entity type:Individual
Prefix:
First Name:SUMITHA
Middle Name:
Last Name:ATLURI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUMITHA
Other - Middle Name:
Other - Last Name:KONGARA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-7208
Mailing Address - Country:US
Mailing Address - Phone:817-920-6300
Mailing Address - Fax:
Practice Address - Street 1:701 TUSCAN DR STE 125
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-3838
Practice Address - Country:US
Practice Address - Phone:214-964-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN4924207R00000X
MI4301080083207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CL733OtherBCBS
TX215872701Medicaid
TX8EQ924OtherBCBS
TXP01055120OtherRAILROAD MEDICARE
TX215872703Medicaid
TXP01055120OtherRAILROAD MEDICARE
TXTXB110104Medicare PIN
TN379856YT1DMedicare PIN
TX215872701Medicaid