Provider Demographics
NPI:1427443886
Name:SYLAZA KANTAMNENI MEDICAL PC
Entity type:Organization
Organization Name:SYLAZA KANTAMNENI MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SYLAZA
Authorized Official - Middle Name:
Authorized Official - Last Name:KANTAMNENI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-707-0521
Mailing Address - Street 1:2908 GREENFIELD CT
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-3896
Mailing Address - Country:US
Mailing Address - Phone:972-707-0521
Mailing Address - Fax:
Practice Address - Street 1:2908 GREENFIELD CT
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-3896
Practice Address - Country:US
Practice Address - Phone:972-707-0521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP9209208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty