Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | M4314 | TX |
NPI | 1023050812 |
---|---|
Provider Name | Dr. Yamini K Maddala |
First Address | Dallas, TX 75247-4228 |
Second Address | Allen, TX 75013 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2006 |
Last Update Date | 03/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
185054701 | (05) | TX |
8B4314 | BCBSTX (01) | TX |
H64399 | (02) | TX |