MEDICARE: DR. NAGAPRASADARAO MUMMANENI 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	207LP2900X	Pain Medicine (Anesthesiology) Physician	G4175	TX
2	207L00000X	Anesthesiology Physician	G4175	TX

General Provider Information

NPI Number	:	1861434128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NAGAPRASADARAO MUMMANENI MD

Provider Business Mailing Address
First Line	:	3617 GLENHOME DR
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75025-0118
Country	:	US
Telephone Number	:	248-425-8880
Fax Number	:	--

Provider Business Practice Location Address
First Line	:	3617 GLENHOME DR
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75025-0118
Country	:	US
Telephone Number	:	248-425-8880
Fax Number	:	--

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

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	08/26/2021

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