MEDICARE: DR. VIVEK A PADEGAL 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	207RP1001X	Pulmonary Disease Physician	K4181	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	2900014771	OTHER	TX	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0054288	OTHER	TX	BLUE LINK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	8B7952	OTHER	TX	BLUE CROSS/BLUE SHIELD
5	2143771	OTHER	TX	UNITED HEALTHCARE
6	2676528	OTHER	TX	AETNA
7	55374102	OTHER	TX	CIGNA

General Provider Information

NPI Number	:	1427026236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIVEK A PADEGAL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 117506
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75011-7506
Country	:	US
Telephone Number	:	972-241-4208
Fax Number	:	972-241-7189

Provider Business Practice Location Address
First Line	:	10 MEDICAL PKWY
Second Line	:	SUITE 301
City	:	DALLAS
State	:	TX
Zip	:	75234-7840
Country	:	US
Telephone Number	:	972-241-4208
Fax Number	:	972-241-7189

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

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	09/08/2009

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Directions to “ DR. VIVEK A PADEGAL M.D.” Practice Location

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