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NPI Code Detail

MEDICARE: RAVIKUMAR KANNEGANTI MD PA

MEDICARE: RAVIKUMAR KANNEGANTI MD PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialistH6867TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1013217603
Entity Type Code : Organization
Provider Name (Legal Business Name) : RAVIKUMAR KANNEGANTI MD PA
Provider Business Mailing Address
First Line : PO BOX 21313
Second Line :
City : BEAUMONT
State : TX
Zip : 77720-1313
Country : US
Telephone Number : 409-813-1765
Fax Number : 409-813-1875
Provider Business Practice Location Address
First Line : 3250 MEDICAL CENTER DR
Second Line :
City : BEAUMONT
State : TX
Zip : 77701-4627
Country : US
Telephone Number : 409-813-1765
Fax Number : 409-813-1875
Authorized Official
Title or Position : PSYCHIATRIST
Name : DR. RAVIKUMAR KANNEGANTI
Credential : M.D.
Telephone Number : 409-813-1765
Provider Enumeration Date : 10/28/2010
Last Update Date : 10/28/2010

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