Healthcare Provider Details

I. General information

NPI: 1003308925
Provider Name (Legal Business Name): DR. SRIKAR VEGESNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 06/02/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 ANNEX, E MCDOWELL RD
PHOENIX AZ
85006-2506
US

IV. Provider business mailing address

755 ANNEX, E MCDOWELL RD
PHOENIX AZ
85006-2506
US

V. Phone/Fax

Practice location:
  • Phone: 480-412-3684
  • Fax:
Mailing address:
  • Phone: 480-412-3684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD475299
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number76780
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: