Provider Demographics
NPI:1427654441
Name:PROSPER RHEUMATOLOGY PLLC
Entity type:Organization
Organization Name:PROSPER RHEUMATOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HIRANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DODANWALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-666-0165
Mailing Address - Street 1:4645 AVON LN STE 215
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-1614
Mailing Address - Country:US
Mailing Address - Phone:469-666-0165
Mailing Address - Fax:608-305-8760
Practice Address - Street 1:4645 AVON LN STE 215
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-1614
Practice Address - Country:US
Practice Address - Phone:469-666-0165
Practice Address - Fax:608-305-8760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-06
Last Update Date:2020-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty