MEDICARE: TEJASWI KATAKAM 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
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207Q00000X	Family Medicine Physician	V1508	TX

General Provider Information

NPI Number	:	1629647755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEJASWI KATAKAM MD

Provider Business Mailing Address
First Line	:	613 16TH ST
Second Line	:
City	:	ARGYLE
State	:	TX
Zip	:	76226-3389
Country	:	US
Telephone Number	:	571-309-5636
Fax Number	:

Provider Business Practice Location Address
First Line	:	3041 CHURCHILL DR STE 500
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75022-5910
Country	:	US
Telephone Number	:	214-666-6259
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2021
Last Update Date	:	05/18/2026

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