MEDICARE: DR. THIMMAIAH GANAPATHI THEETHIRA 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	207R00000X	Internal Medicine Physician	A135528	CA
2	207RG0100X	Gastroenterology Physician	A135528	CA

General Provider Information

NPI Number	:	1225284359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THIMMAIAH GANAPATHI THEETHIRA M.D.,

Provider Business Mailing Address
First Line	:	3400 DATA DR
Second Line	:
City	:	RANCHO CORDOVA
State	:	CA
Zip	:	95670-7956
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8120 TIMBERLAKE WAY STE 107
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-5413
Country	:	US
Telephone Number	:	916-661-6000
Fax Number	:	916-661-6188

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

Provider Enumeration Date	:	08/08/2008
Last Update Date	:	01/13/2021

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