Healthcare Provider Details

I. General information

NPI: 1043225105
Provider Name (Legal Business Name): VIKAS A GODHANIA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 05/20/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6811 AUSTIN CENTER BLVD # 300
AUSTIN TX
78731-3166
US

IV. Provider business mailing address

6210 E HIGHWAY 290
AUSTIN TX
78723-1142
US

V. Phone/Fax

Practice location:
  • Phone: 512-346-8888
  • Fax: 512-344-0365
Mailing address:
  • Phone: 512-483-9596
  • Fax: 512-406-6216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number1696
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: