MEDICARE: DR. VIKRAM JOSEPH VAZ 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	390200000X	Student in an Organized Health Care Education/Training Program	237034	MA

General Provider Information

NPI Number	:	1104087543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIKRAM JOSEPH VAZ M.D.

Provider Business Mailing Address
First Line	:	1600 ELDRIDGE PKWY APT 3601
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-1667
Country	:	US
Telephone Number	:	281-961-4898
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 ELDRIDGE PKWY APT 3601
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-1667
Country	:	US
Telephone Number	:	281-961-4898
Fax Number	:

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

Provider Enumeration Date	:	06/18/2008
Last Update Date	:	06/18/2008

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