Healthcare Provider Details
I. General information
NPI: 1689504292
Provider Name (Legal Business Name): LUMA PHYSICIAN GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 05/23/2026
Last Update Date: 05/23/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:
III. Provider practice location address
3801 N CENTRAL EXPY STE 302
MCKINNEY TX
75071-8816
US
IV. Provider business mailing address
2501 BUCER CT
MCKINNEY TX
75071-2356
US
V. Phone/Fax
- Phone: 469-438-2985
- Fax:
- Phone: 469-438-2985
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 208000000X |
| Taxonomy | Pediatrics Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
PRAVEENA
K
TALLAPUREDDY
Title or Position: OWNER/MANAGING MEMBER/ PEDIATRICIAN
Credential: MD
Phone: 469-438-2985