MEDICARE: ORTUS MD PA

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	:	1891466157
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTUS MD PA

Provider Business Mailing Address
First Line	:	PO BOX 271827
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75027-1827
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3311 YUCCA DR
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75028-2743
Country	:	US
Telephone Number	:	972-982-7867
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	RANJITHA RISHIKESH
Credential	:	MD
Telephone Number	:	972-982-7867

Provider Enumeration Date	:	09/25/2021
Last Update Date	:	09/25/2021

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