MEDICARE: PROMED HEALTH PLLC

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1487471967
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROMED HEALTH PLLC

Provider Business Mailing Address
First Line	:	11691 INDEPENDENCE PKWY STE 110
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75035-4719
Country	:	US
Telephone Number	:	945-221-6442
Fax Number	:	945-221-6442

Provider Business Practice Location Address
First Line	:	11691 INDEPENDENCE PKWY STE 110
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75035-4719
Country	:	US
Telephone Number	:	945-221-6442
Fax Number	:	945-221-6442

Authorized Official
Title or Position	:	MANAGING OWNER
Name	:	KAVITHA ILAYARAJA
Credential	:	MD
Telephone Number	:	214-347-8800

Provider Enumeration Date	:	09/25/2024
Last Update Date	:	07/15/2025

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Directions to “PROMED HEALTH PLLC ” Practice Location

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