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General NPI Number Information
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NPI Number | 1568248987
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Entity Type | Organization
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Legal Business Name | FORT WORTH PHYSICIANS PLLC
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Dates
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Enumeration Date | 09/01/2023
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Last Update Date | 09/01/2023
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Provider Practice Location Address
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Address Line | 6201 OVERTON RIDGE BLVD
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City | FORT WORTH
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State | TX
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Zip | 76132-3613
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Country | US
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Telephone | 203-224-8568
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Fax |
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Provider Business Mailing Address
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Address Line | 400 MONTPELIER DR
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City | SOUTHLAKE
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State | TX
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Zip | 76092-1335
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | VISHNU ILINENI
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Credential | MD
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Telephone | 203-224-8568
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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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