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General NPI Number Information
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NPI Number | 1215411269
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Entity Type | Organization
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Legal Business Name | SUMMIT PRIMARY CARE AND INTERNAL MEDICINE PLLC
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Dates
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Enumeration Date | 09/15/2018
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Last Update Date | 03/08/2019
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Provider Practice Location Address
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Address Line | 118 LYNN AVE STE 502
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City | LEWISVILLE
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State | TX
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Zip | 75057-3709
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Country | US
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Telephone | 469-909-1931
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Fax |
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Provider Business Mailing Address
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Address Line | 118 LYNN AVE STE 502
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City | LEWISVILLE
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State | TX
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Zip | 75057-3709
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Country | US
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Telephone | 732-589-3271
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | ARUNPRIYA VADIVELU
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Credential | MD
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Telephone | 732-589-3271
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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 |
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License Number State |
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