Individual
DR. KIRAN POLAVARAPU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
12001 SOUTH FWY, SUITE 302, BURLESON, TX 76028-7208
(817) 615-8576
Mailing address
12001 SOUTH FWY, SUITE 302, BURLESON, TX 76028-7208
(817) 615-8576
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
Q0809
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
341974901
—
TX
Enumeration date
03/31/2008
Last updated
01/31/2017
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