Provider Demographics
NPI:1447286471
Name:JANGA, SIREESHA (MD)
Entity type:Individual
Prefix:
First Name:SIREESHA
Middle Name:
Last Name:JANGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6376 BIRDHILL LN
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-0796
Mailing Address - Country:US
Mailing Address - Phone:972-322-7965
Mailing Address - Fax:
Practice Address - Street 1:5204 S HWY 360 STE 400
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-0947
Practice Address - Country:US
Practice Address - Phone:972-755-1785
Practice Address - Fax:972-602-4522
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2663207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177630401Medicaid
TX177630402Medicaid
TX8G1877Medicare PIN
TXI46542Medicare UPIN