Basic Information
| Provider Information | |||||||||
| NPI: | 1295792299 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOTTIPOLU | ||||||||
| FirstName: | PADMAJARANI | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | GOTTIPOLU | ||||||||
| OtherFirstName: | RANI | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5425 W SPRING CREEK PKWY | ||||||||
| Address2: | STE 200 | ||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750244237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9725999600 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8080 INDEPENDENCE PKWY STE 200 | ||||||||
| Address2: | |||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750254002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9725969511 | ||||||||
| FaxNumber: | 9728678163 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2006 | ||||||||
| LastUpdateDate: | 01/23/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 46731 | MN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | N6878 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 291806201 | 05 | TX | MEDICAID | 291806202 | 05 | TX | MEDICAID |