Provider Demographics
NPI:1700614427
Name:PRATHAPAM, TULSIRAM (HCLD, DABMGG, FACMG)
Entity type:Individual
Prefix:DR
First Name:TULSIRAM
Middle Name:
Last Name:PRATHAPAM
Suffix:
Gender:M
Credentials:HCLD, DABMGG, FACMG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1319 MEADOW CREEK DR APT 215
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-7205
Mailing Address - Country:US
Mailing Address - Phone:510-322-0795
Mailing Address - Fax:
Practice Address - Street 1:1319 MEADOW CREEK DR APT 215
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-7205
Practice Address - Country:US
Practice Address - Phone:510-322-0795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2023186207SG0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0205XAllopathic & Osteopathic PhysiciansMedical GeneticsPh.D. Medical Genetics