Dr Phani Bodavula, MD | |
6448 Broadway Blvd, Garland, TX 75043 | |
(972) 216-8500 | |
(972) 216-8521 |
Full Name | Dr Phani Bodavula |
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Gender | Male |
Speciality | Pediatrics |
Location | 6448 Broadway Blvd, Garland, Texas |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1700204690 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208000000X | Pediatrics | 67368 (Wisconsin) | Secondary |
208000000X | Pediatrics | R5085 (Texas) | Primary |
Entity Name | Ascension Medical Group-southeast Wisconsin Inc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1609881077 PECOS PAC ID: 8628980943 Enrollment ID: O20031104000421 |
Entity Name | The Medical College Of Wisconsin Inc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1699720086 PECOS PAC ID: 2668384371 Enrollment ID: O20031120000259 |
Mailing Address | Practice Location Address |
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Dr Phani Bodavula, MD 6448 Broadway Blvd, Garland, TX 75043-5943 Ph: (972) 216-8500 | Dr Phani Bodavula, MD 6448 Broadway Blvd, Garland, TX 75043 Ph: (972) 216-8500 |
Dr. James Trever Rester, M.D. Pediatrics Medicare: Accepting Medicare Assignments Practice Location: Methodist Family Health Center - Firewheel, 4430 Lavon Drive, Ste 350, Garland, TX 75040 Phone: 972-530-8590 Fax: 972-530-8625 | |
Dr. Lubna Shahid Kamal, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 5506 Broadway Blvd, Garland, TX 75043 Phone: 972-303-7070 Fax: 972-303-4343 | |
Alexander Grumberg, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 2231 Peggy Ln, Suite 1, Garland, TX 75042 Phone: 972-272-3502 Fax: 972-205-0544 | |
Lewis R. King, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 802 Hopkins St, Garland Health Center, Garland, TX 75040 Phone: 214-266-0700 Fax: 214-266-0656 | |
Dr. Donna I. Persaud, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 802 Hopkins St, Garland Health Center, Garland, TX 75040 Phone: 214-266-0700 | |
M. Melinda Uhrich, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 3232 Broadway Blvd Ste A, Garland, TX 75043 Phone: 972-587-7126 | |
Dr. Ylicia Lachon Richards, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 1224 Thomasville, Garland, TX 75044 Phone: 972-414-2883 Fax: 972-414-5683 |