Healthcare Provider Details

I. General information

NPI: 1427084797
Provider Name (Legal Business Name): VALLIAMMAI RADHA ANNAMALAI-SLAVIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VALLIAMMAI RADHA ANNAMALAI

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 MUELLER BLVD UTSW AUSTIN PEDIATRICS
AUSTIN TX
78723
US

IV. Provider business mailing address

4900 MUELLER BLVD UTSW AUSTIN PEDIATRICS
AUSTIN TX
78723
US

V. Phone/Fax

Practice location:
  • Phone: 512-324-0165
  • Fax:
Mailing address:
  • Phone: 512-324-0165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberM1472
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: