MEDICARE: DR. YAMINI K MADDALA 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
1	207RG0100X	Gastroenterology Physician	M4314	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	8B4314	OTHER	TX	BCBSTX

General Provider Information

NPI Number	:	1023050812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YAMINI K MADDALA M.D.

Provider Business Mailing Address
First Line	:	210 S PRESTON RD STE 30
Second Line	:
City	:	PROSPER
State	:	TX
Zip	:	75078-3070
Country	:	US
Telephone Number	:	972-408-4410
Fax Number	:	972-408-4411

Provider Business Practice Location Address
First Line	:	981 STATE HIGHWAY 121
Second Line	:	SUITE 1140
City	:	ALLEN
State	:	TX
Zip	:	75013
Country	:	US
Telephone Number	:	469-697-5100
Fax Number	:	469-697-5105

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	06/24/2026

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Directions to “ DR. YAMINI K MADDALA M.D.” Practice Location

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