Provider Demographics
NPI:1649614694
Name:PANUGANTI, PRADEEP KUMAR (MB,BS)
Entity type:Individual
Prefix:
First Name:PRADEEP
Middle Name:KUMAR
Last Name:PANUGANTI
Suffix:
Gender:M
Credentials:MB,BS
Other - Prefix:
Other - First Name:PRADEEP
Other - Middle Name:
Other - Last Name:PANUGANTI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MB,BS
Mailing Address - Street 1:4700 ALLIANCE BLVD
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5323
Mailing Address - Country:US
Mailing Address - Phone:469-814-2000
Mailing Address - Fax:
Practice Address - Street 1:4700 ALLIANCE BLVD
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5323
Practice Address - Country:US
Practice Address - Phone:469-814-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-22
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR32932084N0400X
TXS93732084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology