Healthcare Provider Details

I. General information

NPI: 1376947135
Provider Name (Legal Business Name): VIKRAM PALKAR DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: VALKRAM NEELKANTH PALKAR DO

II. Dates (important events)

Enumeration Date: 10/22/2014
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 N CURTIS RD STE 101
BOISE ID
83706-1348
US

IV. Provider business mailing address

1500 S MAIN ST
FORT WORTH TX
76104-4917
US

V. Phone/Fax

Practice location:
  • Phone: 208-302-2800
  • Fax: 208-302-2825
Mailing address:
  • Phone: 817-702-1172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number25MB09673900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberO-1950
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number0102208783
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: