MEDICARE: DR. RAGHUVEER VANGURU 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	207RN0300X	Nephrology Physician	P3262	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700891579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAGHUVEER VANGURU M.D.

Provider Business Mailing Address
First Line	:	1600 WATERS RIDGE DR STE A
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75057-6039
Country	:	US
Telephone Number	:	940-320-1708
Fax Number	:	940-320-1708

Provider Business Practice Location Address
First Line	:	10700 VICTORIA ASH DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-6392
Country	:	US
Telephone Number	:	817-380-4168
Fax Number	:	817-562-5560

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

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	08/27/2024

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