MEDICARE: PRASAD VENKATA KANNAEGANTI 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	207RN0300X	Nephrology Physician	N1701	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

General Provider Information

NPI Number	:	1114922630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRASAD VENKATA KANNAEGANTI MD

Provider Business Mailing Address
First Line	:	1600 WATERS RIDGE DR STE A
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75057-6039
Country	:	US
Telephone Number	:	972-219-0558
Fax Number	:	214-466-7237

Provider Business Practice Location Address
First Line	:	6331 BOULEVARD 26
Second Line	:	SUITE 220
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-1590
Country	:	US
Telephone Number	:	817-628-0284
Fax Number	:	817-628-0288

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

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	12/19/2023

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