Healthcare Provider Details

I. General information

NPI: 1295299808
Provider Name (Legal Business Name): ADVANCED INTERNAL MEDICINE PRACTICE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2019
Last Update Date: 03/08/2024
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1418 WALKERS WAY STE 101
SAN ANTONIO TX
78216-7752
US

IV. Provider business mailing address

2313 LOCKHILL SELMA RD STE 102
SAN ANTONIO TX
78230-3007
US

V. Phone/Fax

Practice location:
  • Phone: 210-245-7933
  • Fax: 210-761-3824
Mailing address:
  • Phone: 210-245-7933
  • Fax: 210-855-8033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SUJATHA GERINENI
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 248-766-4888