MEDICARE: PRADHAN ORTHOPAEDICS MD, PA

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	207X00000X	Orthopaedic Surgery Physician		TX

General Provider Information

NPI Number	:	1346505971
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRADHAN ORTHOPAEDICS MD, PA

Provider Business Mailing Address
First Line	:	8230 WALNUT HILL LN STE 708
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-4431
Country	:	US
Telephone Number	:	214-890-0906
Fax Number	:	214-890-0929

Provider Business Practice Location Address
First Line	:	8230 WALNUT HILL LN STE 708
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-4431
Country	:	US
Telephone Number	:	214-890-0906
Fax Number	:	214-890-0929

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	ANUPAM PRADHAN
Credential	:	M.D.
Telephone Number	:	717-877-3443

Provider Enumeration Date	:	07/10/2012
Last Update Date	:	07/10/2012

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