MEDICARE: PROSPERITY EP MEDICAL GROUP, PLLC

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

General Provider Information

NPI Number	:	1275482747
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROSPERITY EP MEDICAL GROUP, PLLC

Provider Business Mailing Address
First Line	:	4747 HONDO PASS DR STE N&O
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79904-1482
Country	:	US
Telephone Number	:	915-308-7310
Fax Number	:	915-308-7311

Provider Business Practice Location Address
First Line	:	4747 HONDO PASS DR
Second Line	:	STE N&O
City	:	EL PASO
State	:	TX
Zip	:	79904-1482
Country	:	US
Telephone Number	:	915-308-7310
Fax Number	:	915-308-7311

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	MAANIT KOHLI
Credential	:
Telephone Number	:	915-308-7310

Provider Enumeration Date	:	01/27/2026
Last Update Date	:	04/08/2026

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