| Idexpertcare PA | |
|
1634 Mistletoe Blvd Fort Worth TX 76104-4012 | |
| (817) 818-8433 | |
| Not Available |
| Full Name | Idexpertcare PA |
|---|---|
| Speciality | Internal Medicine |
| Location | 1634 Mistletoe Blvd, Fort Worth, Texas |
| Authorized Official Name and Position | Anupama Chennupati (OWNER) |
| Authorized Official Contact | 8176086978 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Idexpertcare PA 912 Charleston Dr Southlake TX 76092-1536 | Idexpertcare PA 1634 Mistletoe Blvd Fort Worth TX 76104-4012 Ph: (817) 818-8433 |
| NPI Number | 1598235194 |
|---|---|
| Provider Enumeration Date | 11/27/2018 |
| Last Update Date | 05/07/2024 |
| Certification Date | 05/07/2024 |
| Medicare PECOS PAC ID | 2860738234 |
|---|---|
| Medicare Enrollment ID | O20190107002895 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598235194 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | () | Primary |
| Provider Name | Anupama Chennupati |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1023258043 PECOS PAC ID: 1355483900 Enrollment ID: I20151002000439 |
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