1831197656 NPI number — SRIDEVI PANCHAMUKHI M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831197656 NPI number — SRIDEVI PANCHAMUKHI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PANCHAMUKHI
Provider First Name:
SRIDEVI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PYDIKONDALA
Provider Other First Name:
SRIDEVI
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1831197656
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/03/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/31/2006
NPI Reactivation Date:
05/01/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6863 ELDARICA PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRISCO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75034-8352
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-325-1093
Provider Business Mailing Address Fax Number:
855-592-0913

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9925 GILLESPIE DR STE 2400
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75025-1099
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-905-1550
Provider Business Practice Location Address Fax Number:
855-592-0913
Provider Enumeration Date:
07/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  R7081 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: 036-101393 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: H12137 . This is a "CHAMPVA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: H12137 . This is a "UNITED HEALTHCARE RR MEDI" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: H12137 . This is a "TRICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 055761 . This is a "HEALTH ALLIANCE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 422714 . This is a "HEALTHLINK" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036-101393 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 036101393 . This is a "IDPA FEE FOR SERVICE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: H12137 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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