Healthcare Provider Details

I. General information

NPI: 1962592436
Provider Name (Legal Business Name): VINAY KUTAGULA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 04/04/2022
Certification Date: 04/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4708 ALLIANCE BLVD PAV 1, SUITE 550
PLANO TX
75093-5340
US

IV. Provider business mailing address

4708 ALLIANCE BLVD PAV 1, SUITE 550
PLANO TX
75093-5340
US

V. Phone/Fax

Practice location:
  • Phone: 469-800-6140
  • Fax: 469-800-6145
Mailing address:
  • Phone: 469-800-6140
  • Fax: 469-800-6145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberP2886
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: