Basic Information
| Provider Information | |||||||||
| NPI: | 1295969699 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOKALA | ||||||||
| FirstName: | RAMAKRISHNA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3302 W GOLF COURSE RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | MIDLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 797035110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4325222304 | ||||||||
| FaxNumber: | 4325222307 | ||||||||
| Practice Location | |||||||||
| Address1: | 3302 W GOLF COURSE RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | MIDLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 79703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4325222304 | ||||||||
| FaxNumber: | 4325222307 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2009 | ||||||||
| LastUpdateDate: | 03/26/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | R6690 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207R00000X | 2015025783 | MO | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1295969699 | 05 | MO | MEDICAID | 384437501 | 05 | TX | MEDICAID |