MEDICARE: SANTHI PENMETSA MD

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	K9634	TX
2	207RR0500X	Rheumatology Physician	K9634	TX
3	207RR0500X	Rheumatology Physician	25MA13171000	NJ

General Provider Information

NPI Number	:	1528148947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANTHI PENMETSA MD

Provider Business Mailing Address
First Line	:	211 E AVENUE G #1358
Second Line	:
City	:	MIDLOTHIAN
State	:	TX
Zip	:	76065-3039
Country	:	US
Telephone Number	:	972-972-4443
Fax Number	:	972-972-4470

Provider Business Practice Location Address
First Line	:	423 E MAIN ST
Second Line	:	STE 1
City	:	MIDLOTHIAN
State	:	TX
Zip	:	76065-3345
Country	:	US
Telephone Number	:	972-972-4443
Fax Number	:	972-972-4470

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	06/23/2026

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