Healthcare Provider Details

I. General information

NPI: 1104388024
Provider Name (Legal Business Name): AMITHA MADHURI AVASARALA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5920 W WILLIAM CANNON DR STE 150
AUSTIN TX
78749-1902
US

IV. Provider business mailing address

1513 E NEW HOPE DR BLDG B
CEDAR PARK TX
78641-5760
US

V. Phone/Fax

Practice location:
  • Phone: 512-441-9799
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number036.164758
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberW7962
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: