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General NPI Number Information
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NPI Number | 1609015312
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Entity Type | Individual
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Provider Name | SIRISHA BHEEMANENI M.D
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Gender | Female
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Dates
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Enumeration Date | 02/19/2009
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Last Update Date | 04/26/2013
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Provider Practice Location Address
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Address Line | 11801 S FRWY
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City | FORT WORTH
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State | TX
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Zip | 76115
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Country | US
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Telephone | 817-568-5955
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Fax |
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Provider Business Mailing Address
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Address Line | 9825 N MACARTHUR BLVD APT 1205
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City | IRVING
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State | TX
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Zip | 75063-7188
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Country | US
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Telephone | 903-707-1521
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | P1050
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License Number State | TX
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