MEDICARE: PRO MED ANESTHESIA CONSULTANTS 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	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1316260318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRO MED ANESTHESIA CONSULTANTS PLLC

Provider Business Mailing Address
First Line	:	PO BOX 8
Second Line	:
City	:	LITTLE ELM
State	:	TX
Zip	:	75068-0008
Country	:	US
Telephone Number	:	214-550-5399
Fax Number	:

Provider Business Practice Location Address
First Line	:	6356 MALCOLM DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75214-3022
Country	:	US
Telephone Number	:	214-550-5399
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	KIMBERLY R SIVARAMAN
Credential	:
Telephone Number	:	214-550-5399

Provider Enumeration Date	:	03/04/2010
Last Update Date	:	03/04/2010

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