MEDICARE: DR. PRAVEEN GUNTIPALLI 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	207RB0002X	Obesity Medicine (Internal Medicine) Physician	P3336	TX
2	208M00000X	Hospitalist Physician	P3336	TX
3	207R00000X	Internal Medicine Physician	P3336	TX

General Provider Information

NPI Number	:	1881820025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PRAVEEN GUNTIPALLI MD

Provider Business Mailing Address
First Line	:	5633 W LOVERS LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75209-4309
Country	:	US
Telephone Number	:	214-245-9999
Fax Number	:

Provider Business Practice Location Address
First Line	:	5633 W LOVERS LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75209-4309
Country	:	US
Telephone Number	:	214-245-9999
Fax Number	:

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

Provider Enumeration Date	:	06/02/2009
Last Update Date	:	06/15/2023

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