# IDEXPERTCARE PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1598235194
- **Authorized official:** ANUPAMA CHENNUPATI MD (OWNER)
- **Authorized official phone:** (817) 608-6978

## Contact information

- **Practice address:** 1634 MISTLETOE BLVD, FORT WORTH, TX 76104-4012
- **Practice address phone:** (817) 818-8433
- **Mailing address:** 912 CHARLESTON DR, SOUTHLAKE, TX 76092-1536

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RI0200X | Infectious Disease Physician | — | NULL | Yes |
| 207RI0200X | Infectious Disease Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/27/2018
- **Last updated:** 05/07/2024