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General NPI Number Information
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NPI Number | 1174046452
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Entity Type | Organization
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Legal Business Name | VITALS FAMILY MEDICINE PLLC
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Dates
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Enumeration Date | 07/19/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1420 W EXCHANGE PKWY STE 120
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City | ALLEN
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State | TX
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Zip | 75013-4696
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Country | US
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Telephone | 972-521-6210
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Fax |
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Provider Business Mailing Address
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Address Line | 2317 HIGH COUNTRY WAY
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City | PLANO
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State | TX
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Zip | 75025-4781
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Country | US
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Telephone | 972-521-6210
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROOPAM SHYAM
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Credential |
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Telephone | 972-521-6210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | M6396
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License Number State | TX
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