Provider Demographics
NPI:1417758541
Name:PROHEALTH STUDIO FAMILY PRACTICE & PEDIATRICS PLLC
Entity type:Organization
Organization Name:PROHEALTH STUDIO FAMILY PRACTICE & PEDIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PURNACHANDER
Authorized Official - Middle Name:R
Authorized Official - Last Name:SIRIKONDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-473-4120
Mailing Address - Street 1:12071 TOSCANA WAY
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-2293
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4645 WYNDHAM LN STE 230
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-0024
Practice Address - Country:US
Practice Address - Phone:469-473-4120
Practice Address - Fax:817-417-9008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty