Healthcare Provider Details

I. General information

NPI: 1720583941
Provider Name (Legal Business Name): VIVEK SREERAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2018
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21212 NORTHWEST FWY STE 275
CYPRESS TX
77429-5883
US

IV. Provider business mailing address

PO BOX 739526
DALLAS TX
75373-9526
US

V. Phone/Fax

Practice location:
  • Phone: 713-400-6325
  • Fax: 281-970-9424
Mailing address:
  • Phone: 713-400-6325
  • Fax: 281-970-9424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberW8445
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: