Provider Demographics
NPI:1538826474
Name:NAMIRA HEALTH PLLC
Entity type:Organization
Organization Name:NAMIRA HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RAGHAVENDER
Authorized Official - Middle Name:
Authorized Official - Last Name:GOTUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:417-894-2865
Mailing Address - Street 1:401 IVY ARBOR WAY
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-4812
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:401 IVY ARBOR WAY
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-4812
Practice Address - Country:US
Practice Address - Phone:417-894-2865
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-28
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty