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General NPI Number Information
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NPI Number | 1316989023
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Entity Type | Individual
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Provider Name | VIVEK MAHENDRU MD
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Gender | Male
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Dates
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Enumeration Date | 06/10/2006
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Last Update Date | 10/26/2017
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Provider Practice Location Address
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Address Line | 4100 DUVAL RD BLDG III SUITE 200
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City | AUSTIN
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State | TX
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Zip | 78759-4275
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Country | US
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Telephone | 512-485-7200
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Fax | 512-485-7220
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Provider Business Mailing Address
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Address Line | 4100 DUVAL RD BLDG III SUITE 200
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City | AUSTIN
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State | TX
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Zip | 78759-4275
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Country | US
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Telephone | 512-485-7200
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Fax | 512-485-7220
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | J7566
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | J7566
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License Number State | TX
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