| Sreevani Kuncham, Md, Pa | |
|
273 W Church St., Suite 100 Lewisville TX 75057 | |
| (972) 436-7424 | |
| (972) 219-0343 |
| Full Name | Sreevani Kuncham, Md, Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 273 W Church St., Suite 100, Lewisville, Texas |
| Authorized Official Name and Position | Sreevani Kuncham (MD, PA) |
| Authorized Official Contact | 9724367424 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sreevani Kuncham, Md, Pa 273 W Church St., Suite 100 Lewisville TX 75057 Ph: (972) 436-7424 | Sreevani Kuncham, Md, Pa 273 W Church St., Suite 100 Lewisville TX 75057 Ph: (972) 436-7424 |
| NPI Number | 1255860391 |
|---|---|
| Provider Enumeration Date | 06/11/2017 |
| Last Update Date | 08/19/2022 |
| Medicare PECOS PAC ID | 7517233349 |
|---|---|
| Medicare Enrollment ID | O20171024000654 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255860391 | NPI | - | NPPES |
| 1528030210 | Other | TX | PERSONAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | L5423 (Texas) | Primary |
| Provider Name | Sreevani Kuncham |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1528030210 PECOS PAC ID: 3971561226 Enrollment ID: I20050103000765 |
| Provider Name | Mai Thanh Nguyen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093496424 PECOS PAC ID: 5294180030 Enrollment ID: I20231013000936 |
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