MEDICARE: NEUROLOGY ASSOCIATES OF TEXAS, 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	174400000X	Specialist

General Provider Information

NPI Number	:	1477172013
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROLOGY ASSOCIATES OF TEXAS, PLLC

Provider Business Mailing Address
First Line	:	1110 COTTONWOOD LN STE 205
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75038-6111
Country	:	US
Telephone Number	:	214-727-8900
Fax Number	:

Provider Business Practice Location Address
First Line	:	1110 COTTONWOOD LN STE 205
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75038-6111
Country	:	US
Telephone Number	:	214-727-8900
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	DR. KISHORI VENKATA LAXMI SOMYREDDY
Credential	:	MD
Telephone Number	:	214-727-8900

Provider Enumeration Date	:	04/14/2020
Last Update Date	:	04/14/2020

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