Healthcare Provider Details

I. General information

NPI: 1245213222
Provider Name (Legal Business Name): VIJAY N KOLI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 07/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 PALO ALTO RD 300
SAN ANTONIO TX
78211-3791
US

IV. Provider business mailing address

102 PALO ALTO RD 300
SAN ANTONIO TX
78211-3791
US

V. Phone/Fax

Practice location:
  • Phone: 210-924-5097
  • Fax: 210-924-1116
Mailing address:
  • Phone: 210-924-5097
  • Fax: 210-924-1116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberF3197
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: