MEDICARE: PRASANTHI TONDAPU 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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	M5547	TX
2	207R00000X	Internal Medicine Physician	M5547	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P01119012	OTHER	TX	RAILROAD MEDICARE

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023210382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRASANTHI TONDAPU M.D.

Provider Business Mailing Address
First Line	:	4505 BRENDA DR
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75022-1001
Country	:	US
Telephone Number	:	469-930-4655
Fax Number	:	877-776-3240

Provider Business Practice Location Address
First Line	:	3311 YUCCA DR STE 100
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75028-2743
Country	:	US
Telephone Number	:	469-930-4655
Fax Number	:	877-776-3240

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

Provider Enumeration Date	:	05/31/2007
Last Update Date	:	07/14/2025

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Directions to “ PRASANTHI TONDAPU M.D.” Practice Location

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