Individual
DR. PRAVEEN K TAMIRISA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11803 SOUTH FWY STE 115, BURLESON, TX 76028-7028
(817) 293-8441
(817) 293-8505
Mailing address
11803 SOUTH FWY STE 115, BURLESON, TX 76028-7028
(817) 293-8441
(817) 293-8505
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
35079630T
OH
207RC0000X
Cardiovascular Disease Physician
4301077499
MI
207RI0011X
Interventional Cardiology Physician
4301077499
MI
207RI0011X
Interventional Cardiology Physician
Primary
S2912
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2258971
—
OH
01
—
P00711902
RRMC
—
Enumeration date
06/09/2005
Last updated
10/28/2020
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