Healthcare Provider Details

I. General information

NPI: 1174752372
Provider Name (Legal Business Name): SRINIVAS YALLAPRAGADA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2009
Last Update Date: 05/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8440 WALNUT HILL LN STE 700
DALLAS TX
75231
US

IV. Provider business mailing address

8440 WALNUT HILL LN STE 700
DALLAS TX
75231-3824
US

V. Phone/Fax

Practice location:
  • Phone: 214-361-3300
  • Fax:
Mailing address:
  • Phone: 214-361-3300
  • Fax: 214-361-3431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberQ9557
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code193200000X
TaxonomyMulti-Specialty Group
License NumberQ9557
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: