MEDICARE: UNKNOWN PRIYANKA MD

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	207R00000X	Internal Medicine Physician	S5049	TX

General Provider Information

NPI Number	:	1063677706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	UNKNOWN PRIYANKA MD

Provider Business Mailing Address
First Line	:	1207 S WHITE CHAPEL BLVD STE 275
Second Line	:
City	:	SOUTHLAKE
State	:	TX
Zip	:	76092-9345
Country	:	US
Telephone Number	:	682-416-9120
Fax Number	:

Provider Business Practice Location Address
First Line	:	1207 S WHITE CHAPEL BLVD STE 275
Second Line	:
City	:	SOUTHLAKE
State	:	TX
Zip	:	76092-9345
Country	:	US
Telephone Number	:	682-416-9120
Fax Number	:

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

Provider Enumeration Date	:	07/22/2008
Last Update Date	:	01/29/2024

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Directions to “ UNKNOWN PRIYANKA MD” Practice Location

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