Basic Information
| Provider Information | |||||||||
| NPI: | 1003003609 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PAKKIVENKATA | ||||||||
| FirstName: | UMA | ||||||||
| MiddleName: | B.R.K | ||||||||
| NamePrefix: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9900 N CENTRAL EXPY STE 215 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752310929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143964950 | ||||||||
| FaxNumber: | 8774235360 | ||||||||
| Practice Location | |||||||||
| Address1: | 9900 N CENTRAL EXPY STE 215 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752310929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143964950 | ||||||||
| FaxNumber: | 8774235360 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2007 | ||||||||
| LastUpdateDate: | 07/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N3969 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 0101249410 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RN0300X | N3969 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 3127078 | 05 | TX | MEDICAID |