Provider Demographics
NPI:1457645830
Name:NATAKAL PAKEERAPPA, PRAVEEN (MD)
Entity Type:Individual
Prefix:
First Name:PRAVEEN
Middle Name:
Last Name:NATAKAL PAKEERAPPA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:BONHAM
Mailing Address - State:TX
Mailing Address - Zip Code:75418-0429
Mailing Address - Country:US
Mailing Address - Phone:859-825-8504
Mailing Address - Fax:972-767-0181
Practice Address - Street 1:1055 CLARKSVILLE ST STE 165
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-0211
Practice Address - Country:US
Practice Address - Phone:903-401-5145
Practice Address - Fax:903-401-5145
Is Sole Proprietor?:No
Enumeration Date:2011-06-03
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS0516208100000X
ARE9660208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR941244488OtherDRIVER LICENSE