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General NPI Number Information
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NPI Number | 1972969640
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Entity Type | Organization
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Legal Business Name | VKN HEALTH SERVICES PLLC
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Dates
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Enumeration Date | 01/11/2016
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Last Update Date | 06/23/2025
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Provider Practice Location Address
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Address Line | 1209 ROTHSCHILD BLVD
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City | SOUTHLAKE
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State | TX
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Zip | 76092-1404
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Country | US
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Telephone | 614-314-8366
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Fax |
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Provider Business Mailing Address
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Address Line | 1619 BOX CANYON CT
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City | GRAPEVINE
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State | TX
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Zip | 76051-4719
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Country | US
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Telephone | 614-873-5184
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GRAGEYI BANDARU
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Credential | MD
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Telephone | 614-873-5184
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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 | Q2734
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License Number State | TX
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