Healthcare Provider Details

I. General information

NPI: 1558439505
Provider Name (Legal Business Name): BHUPATRAI G VACHHANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 05/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6503 ANTOINE DR
HOUSTON TX
77091-1203
US

IV. Provider business mailing address

6503 ANTOINE DR
HOUSTON TX
77091-1203
US

V. Phone/Fax

Practice location:
  • Phone: 713-686-1835
  • Fax: 713-686-0379
Mailing address:
  • Phone: 713-686-1835
  • Fax: 713-686-0379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG1792
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: