Healthcare Provider Details

I. General information

NPI: 1225514680
Provider Name (Legal Business Name): PIONEER MEDICAL ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14111 KING RD STE 320
FRISCO TX
75036-8981
US

IV. Provider business mailing address

14111 KING RD STE 320
FRISCO TX
75036-0810
US

V. Phone/Fax

Practice location:
  • Phone: 469-888-4890
  • Fax:
Mailing address:
  • Phone: 469-888-4890
  • Fax: 866-292-0929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: KIRAN KUMAR R MANGALPALLY
Title or Position: OWNER
Credential:
Phone: 945-222-4111