Provider Demographics
NPI:1295299808
Name:ADVANCED INTERNAL MEDICINE PRACTICE PLLC
Entity type:Organization
Organization Name:ADVANCED INTERNAL MEDICINE PRACTICE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUJATHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GERINENI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-766-4888
Mailing Address - Street 1:2313 LOCKHILL SELMA RD STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-3007
Mailing Address - Country:US
Mailing Address - Phone:210-245-7933
Mailing Address - Fax:210-855-8033
Practice Address - Street 1:1418 WALKERS WAY STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-7752
Practice Address - Country:US
Practice Address - Phone:210-245-7933
Practice Address - Fax:210-761-3824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-28
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1295299808OtherGROUP NPI
TX1396973640OtherNPI