MEDICARE: VIDYA JAGADEESAN MD

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	207R00000X	Internal Medicine Physician	P25847	MD
2	207RI0200X	Infectious Disease Physician	U5131	TX

General Provider Information

NPI Number	:	1720391915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIDYA JAGADEESAN MD

Provider Business Mailing Address
First Line	:	PO BOX 845347
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-5347
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2201 INWOOD RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-7320
Country	:	US
Telephone Number	:	214-645-4673
Fax Number	:

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

Provider Enumeration Date	:	07/16/2010
Last Update Date	:	08/21/2023

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