MEDICARE: GIFTED HANDS HOUSECALL INC

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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1588106603
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GIFTED HANDS HOUSECALL INC

Provider Business Mailing Address
First Line	:	801 RAINBOW DR
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75081-4418
Country	:	US
Telephone Number	:	214-457-3717
Fax Number	:

Provider Business Practice Location Address
First Line	:	1221 W AIRPORT FWY STE 209
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75062-6209
Country	:	US
Telephone Number	:	214-455-5028
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LEONA R KOLLURI
Credential	:
Telephone Number	:	214-457-3717

Provider Enumeration Date	:	11/07/2016
Last Update Date	:	12/05/2025

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