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General NPI Number Information
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NPI Number | 1982720199
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Entity Type | Individual
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Provider Name | RENUKA VIJAY BASAVARAJU M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 08/13/2024
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Provider Practice Location Address
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Address Line | 2021 N MACARTHUR BLVD STE 225
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City | IRVING
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State | TX
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Zip | 75061-2219
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Country | US
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Telephone | 972-253-4370
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Fax | 855-808-8622
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Provider Business Mailing Address
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Address Line | 5350 INDEPENDENCE PKWY STE 100
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City | FRISCO
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State | TX
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Zip | 75035-4653
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Country | US
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Telephone | 972-253-4370
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Fax | 855-808-8622
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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 | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | K9020
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | K9020
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License Number State | TX
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