MEDICARE: TARRANT NEUROLOGY CONSULTANTS, P.A.

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	2084N0400X	Neurology Physician

General Provider Information

NPI Number	:	1740509843
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TARRANT NEUROLOGY CONSULTANTS, P.A.

Provider Business Mailing Address
First Line	:	713 GRAINGER ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-7505
Country	:	US
Telephone Number	:	817-336-3968
Fax Number	:	817-336-3917

Provider Business Practice Location Address
First Line	:	713 GRAINGER ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-7505
Country	:	US
Telephone Number	:	817-336-3968
Fax Number	:	817-336-3917

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	DR. KRISHNABABU CHUNDURI
Credential	:	M.D.
Telephone Number	:	817-336-3968

Provider Enumeration Date	:	05/28/2010
Last Update Date	:	11/12/2010

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