Healthcare Provider Details

I. General information

NPI: 1922236660
Provider Name (Legal Business Name): ANIL KUMAR NALUBOTULA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2009
Last Update Date: 02/20/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 W TERRELL AVE STE K230
FORT WORTH TX
76104-3104
US

IV. Provider business mailing address

1631 11TH STREET UNIT B
WICHITA FALLS TX
76301-9470
US

V. Phone/Fax

Practice location:
  • Phone: 817-250-4906
  • Fax:
Mailing address:
  • Phone: 940-263-3000
  • Fax: 940-263-3018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD156807
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301094980
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberQ3247
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: