MEDICARE: DR. VANI VENKATACHALAM MD, FAAP

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	208000000X	Pediatrics Physician	Q5116	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0101254197	OTHER	VA	LICENSE
2	Q5116	OTHER	TX	LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659685709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VANI VENKATACHALAM MD, FAAP

Provider Business Mailing Address
First Line	:	111 TENNYSON PL
Second Line	:
City	:	COPPELL
State	:	TX
Zip	:	75019-5358
Country	:	US
Telephone Number	:	434-228-0388
Fax Number	:

Provider Business Practice Location Address
First Line	:	2651 TEXAS DR STE A
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75062-7016
Country	:	US
Telephone Number	:	972-893-1192
Fax Number	:

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

Provider Enumeration Date	:	07/31/2010
Last Update Date	:	02/24/2022

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