Healthcare Provider Details

I. General information

NPI: 1801052667
Provider Name (Legal Business Name): SWAPNA VATTIKUTI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2008
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 N MAIN ST
EULESS TX
76039-3355
US

IV. Provider business mailing address

910 N MAIN ST
EULESS TX
76039-3355
US

V. Phone/Fax

Practice location:
  • Phone: 817-358-5870
  • Fax: 817-546-8672
Mailing address:
  • Phone: 817-358-5870
  • Fax: 817-546-8672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR0805
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: