MEDICARE: DR. LATA SHRIDHARAN 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	208000000X	Pediatrics Physician	L3125	TX

General Provider Information

NPI Number	:	1982730735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LATA SHRIDHARAN M.D.

Provider Business Mailing Address
First Line	:	2308 ALL SAINTS LN
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75025-5536
Country	:	US
Telephone Number	:	972-618-3547
Fax Number	:	972-618-3547

Provider Business Practice Location Address
First Line	:	2109 W SPRING CREEK PKWY
Second Line	:	SUITE #200
City	:	PLANO
State	:	TX
Zip	:	75023-4189
Country	:	US
Telephone Number	:	469-444-0362
Fax Number	:	972-618-3547

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

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	01/29/2020

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