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NPI Code Detail

MEDICARE: MANOHAR ANGIREKULA M.D.

MEDICARE: MANOHAR ANGIREKULA M.D.
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
1174400000XSpecialistL2101TX
2207RC0000XCardiovascular Disease PhysicianL2101TX
3207RC0000XCardiovascular Disease Physician2002-0295NM

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 : 1023007085
Entity Type Code : Individual
Provider Name (Legal Business Name) : MANOHAR ANGIREKULA M.D.
Provider Business Mailing Address
First Line : 720 GOLDER AVE
Second Line :
City : ODESSA
State : TX
Zip : 79761-4442
Country : US
Telephone Number : 432-337-3117
Fax Number : 432-337-3117
Provider Business Practice Location Address
First Line : 720 GOLDER AVE
Second Line :
City : ODESSA
State : TX
Zip : 79761-4442
Country : US
Telephone Number : 432-337-3117
Fax Number : 432-337-3117
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2005
Last Update Date : 12/17/2014

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Directions to “ MANOHAR ANGIREKULA M.D.” Practice Location

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