Healthcare Provider Details

I. General information

NPI: 1689870511
Provider Name (Legal Business Name): ANBU DURAI MUTHUSAMY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2831 E PRESIDENT GEORGE BUSH HWY
RICHARDSON TX
75082-3561
US

IV. Provider business mailing address

1121 E SPRING CREEK PKWY. STE. 110, #319
PLANO TX
75074-3569
US

V. Phone/Fax

Practice location:
  • Phone: 214-343-6663
  • Fax: 214-343-2814
Mailing address:
  • Phone: 214-343-6663
  • Fax: 214-343-2814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number50578
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberN5270
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: