MEDICARE: DR. SITA M BOPPANA M.D.

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	K3994	TX

General Provider Information

NPI Number	:	1689629123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SITA M BOPPANA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 830066
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75083-0066
Country	:	US
Telephone Number	:	972-644-1100
Fax Number	:	972-644-1107

Provider Business Practice Location Address
First Line	:	2460 N CENTRAL EXPY
Second Line	:	SUITE 101
City	:	RICHARDSON
State	:	TX
Zip	:	75080-2713
Country	:	US
Telephone Number	:	972-644-1100
Fax Number	:	972-644-1107

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

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	06/30/2010

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