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General NPI Number Information
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NPI Number | 1194031633
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Entity Type | Organization
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Legal Business Name | VIJAYA KAVIKONDALA MD PA
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Dates
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Enumeration Date | 08/22/2010
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Last Update Date | 08/22/2010
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Provider Practice Location Address
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Address Line | 4557 KENTUCKY DR
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City | PLANO
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State | TX
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Zip | 75024-3984
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Country | US
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Telephone | 972-491-0795
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Fax | 972-491-0795
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Provider Business Mailing Address
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Address Line | 4557 KENTUCKY DR
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City | PLANO
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State | TX
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Zip | 75024-3984
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Country | US
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Telephone | 972-491-0795
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Fax | 972-491-0795
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. VIJAYA KAVIKONDALA
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Credential | M.D.
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Telephone | 972-804-4936
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | M2666
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License Number State | TX
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