| NPI | 1992210579 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUDATH RANNULU Md 972-296-9930 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| 207Q00000X Family Medicine | |
| 208000000X Pediatrics | |
| Enumeration Date | 2017-12-05 |
| Last Update Date | 2020-04-27 |