Provider Demographics
NPI:1295792299
Name:GOTTIPOLU, PADMAJARANI (MD)
Entity type:Individual
Prefix:
First Name:PADMAJARANI
Middle Name:
Last Name:GOTTIPOLU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RANI
Other - Middle Name:
Other - Last Name:GOTTIPOLU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5425 W SPRING CREEK PKWY
Mailing Address - Street 2:STE 200
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-4237
Mailing Address - Country:US
Mailing Address - Phone:972-599-9600
Mailing Address - Fax:
Practice Address - Street 1:8080 INDEPENDENCE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75025-4002
Practice Address - Country:US
Practice Address - Phone:972-596-9511
Practice Address - Fax:972-867-8163
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN46731207Q00000X
TXN6878207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX291806201Medicaid
TX291806202Medicaid
TX291806202Medicaid
TXTXB146063Medicare PIN
MNI17840Medicare UPIN
TXTXB146067Medicare PIN