Healthcare Provider Details

I. General information

NPI: 1124232384
Provider Name (Legal Business Name): SOUMYA YEMME MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 09/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14131 MIDWAY RD STE 620
ADDISON TX
75001-3669
US

IV. Provider business mailing address

14131 MIDWAY RD STE 620
ADDISON TX
75001-3669
US

V. Phone/Fax

Practice location:
  • Phone: 972-249-0200
  • Fax:
Mailing address:
  • Phone: 972-249-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number36117420
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP0522
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: