MEDICARE: VISHU LAMMATA MD PA

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	207RC0000X	Cardiovascular Disease Physician	G1942	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0082PY	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1124116132
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISHU LAMMATA MD PA

Provider Business Mailing Address
First Line	:	PO BOX 380577
Second Line	:
City	:	DUNCANVILLE
State	:	TX
Zip	:	75138-0577
Country	:	US
Telephone Number	:	972-572-1600
Fax Number	:	972-572-2133

Provider Business Practice Location Address
First Line	:	925 YORK DR
Second Line	:
City	:	DESOTO
State	:	TX
Zip	:	75115-2043
Country	:	US
Telephone Number	:	972-572-1600
Fax Number	:	972-572-2133

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	VISHU LAMMATA
Credential	:
Telephone Number	:	972-572-1600

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	07/20/2012

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