Provider Demographics
NPI:1124470570
Name:PADMA MUNUKUTI, M.D,P.A.
Entity type:Organization
Organization Name:PADMA MUNUKUTI, M.D,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:PADMA
Authorized Official - Middle Name:NAGALAKSHMI
Authorized Official - Last Name:MUNUKUTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-264-9441
Mailing Address - Street 1:2609 WINDING PATH WAY
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-5348
Mailing Address - Country:US
Mailing Address - Phone:678-264-9441
Mailing Address - Fax:
Practice Address - Street 1:2609 WINDING PATH WAY
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-5348
Practice Address - Country:US
Practice Address - Phone:678-264-9441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-11
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN5269261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service