Healthcare Provider Details

I. General information

NPI: 1164687430
Provider Name (Legal Business Name): VIKRAM C SURAPARAJU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2008
Last Update Date: 04/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12221 N MOPAC EXPY
AUSTIN TX
78758-2401
US

IV. Provider business mailing address

12221 N MOPAC EXPY
AUSTIN TX
78758-2401
US

V. Phone/Fax

Practice location:
  • Phone: 512-901-4009
  • Fax: 512-901-3909
Mailing address:
  • Phone: 512-901-4009
  • Fax: 512-901-3909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberN1167
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberN1167
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberN1167
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: