Provider Demographics
NPI:1407671845
Name:AMEVA MEDICAL PLLC
Entity type:Organization
Organization Name:AMEVA MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KIRAN
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:PANUGANTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-286-3577
Mailing Address - Street 1:12963 ALLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-7887
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6601 W UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-4822
Practice Address - Country:US
Practice Address - Phone:469-907-1355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty