MEDICARE: SUKESH C BURJONROPPA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	M9891	TX
2	207UN0901X	Nuclear Cardiology Physician	M9891	TX
3	207RI0011X	Interventional Cardiology Physician	M9891	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467599134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUKESH C BURJONROPPA M.D.

Provider Business Mailing Address
First Line	:	1900 MISTLETOE BLVD
Second Line	:	STE 100
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4048
Country	:	US
Telephone Number	:	817-338-1300
Fax Number	:	682-747-5141

Provider Business Practice Location Address
First Line	:	1300 W TERRELL AVE STE 500
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2810
Country	:	US
Telephone Number	:	817-252-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	11/06/2024

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Directions to “ SUKESH C BURJONROPPA M.D.” Practice Location

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