MEDICARE: VIJI PRADEEP KODUVATH PLLC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1528528114
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIJI PRADEEP KODUVATH PLLC

Provider Business Mailing Address
First Line	:	1837 N GARLAND AVE
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75040-4561
Country	:	US
Telephone Number	:	469-432-4107
Fax Number	:

Provider Business Practice Location Address
First Line	:	1837 N GARLAND AVE
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75040-4561
Country	:	US
Telephone Number	:	469-432-4107
Fax Number	:

Authorized Official
Title or Position	:	BILLING ADMINISTRATOR
Name	:	ALISON TEMPLE
Credential	:
Telephone Number	:	817-757-2902

Provider Enumeration Date	:	03/21/2019
Last Update Date	:	01/13/2026

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