Basic Information
| Provider Information | |||||||||
| NPI: | 1720237498 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KANTAMNENI | ||||||||
| FirstName: | SYLAZA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1105 CENTRAL EXPY N STE 235 | ||||||||
| Address2: | |||||||||
| City: | ALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750136135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727476042 | ||||||||
| FaxNumber: | 9727476043 | ||||||||
| Practice Location | |||||||||
| Address1: | 1105 CENTRAL EXPY N STE 235 | ||||||||
| Address2: | |||||||||
| City: | ALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750136135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727476042 | ||||||||
| FaxNumber: | 9727476043 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2008 | ||||||||
| LastUpdateDate: | 02/24/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 046854 | CT | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | P9209 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.