Healthcare Provider Details

I. General information

NPI: 1720104516
Provider Name (Legal Business Name): VASILI LENDEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 09/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 SHACKLEFORD WEST BLVD
LITTLE ROCK AR
72211-3714
US

IV. Provider business mailing address

7 SHACKLEFORD WEST BLVD
LITTLE ROCK AR
72211-3714
US

V. Phone/Fax

Practice location:
  • Phone: 501-664-5860
  • Fax: 501-664-0889
Mailing address:
  • Phone: 501-664-5860
  • Fax: 501-664-0889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number19763
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number19763
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: