Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | P4112 | TX |
N | 111NI0900X | Internist | P4112 | TX |
N | 207RC0000X | Internist - Cardiovascular Disease | P4112 | TX |
Y | 207RI0011X | Interventional Cardiology | P4112 | TX |
NPI | 1114142403 |
---|---|
Provider Name | Dr. Siva Prasad Sontineni |
First Address | Lewisville, TX 75029-3297 |
Second Address | Denton, TX 76201-2499 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2007 |
Last Update Date | 20/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3514952 | (05) | TX |
P01542377 | MEDICARE RAIL ROAD PTAN (01) | TX |