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NPI Code Detail

MEDICARE: PRAVEEN KONERU MD

MEDICARE: PRAVEEN KONERU 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
1207R00000XInternal Medicine Physician243861MA
2207R00000XInternal Medicine PhysicianQ0090TX
3208M00000XHospitalist PhysicianQ0090TX
4207R00000XInternal Medicine Physician50288WI

General Provider Information

NPI Number : 1235335068
Entity Type Code : Individual
Provider Name (Legal Business Name) : PRAVEEN KONERU MD
Provider Business Mailing Address
First Line : PO BOX 844658
Second Line :
City : DALLAS
State : TX
Zip : 75284-4658
Country : US
Telephone Number : 254-724-2111
Fax Number :
Provider Business Practice Location Address
First Line : 100 MEDICAL PKWY
Second Line :
City : LAKEWAY
State : TX
Zip : 78738-5621
Country : US
Telephone Number : 512-571-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2007
Last Update Date : 01/26/2022

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