MEDICARE: VICHIN PURI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	204F00000X	Transplant Surgery Physician	R1109	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P01473968	OTHER	TN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6002233	OTHER	TN	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003060211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICHIN PURI M.D.

Provider Business Mailing Address
First Line	:	3400 W WHEATLAND RD BLDG 3 # 360
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75237
Country	:	US
Telephone Number	:	214-884-4700
Fax Number	:	214-884-4761

Provider Business Practice Location Address
First Line	:	1411 N. BECKLEY AVE.
Second Line	:	PAVILION III, SUITE 268
City	:	DALLAS
State	:	TX
Zip	:	75203-7520
Country	:	US
Telephone Number	:	214-947-4400
Fax Number	:	214-947-4404

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2008
Last Update Date	:	03/17/2018

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Directions to “ VICHIN PURI M.D.” Practice Location

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