MEDICARE: MID-CITIES INTERNAL MEDICINE, P.A.

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	N4565	TX

General Provider Information

NPI Number	:	1891127056
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID-CITIES INTERNAL MEDICINE, P.A.

Provider Business Mailing Address
First Line	:	6703 CAPISTRANO ST
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75039-4339
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6703 CAPISTRANO ST
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75039-4339
Country	:	US
Telephone Number	:	214-282-3188
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	DR. VANDANA MADDALI
Credential	:	M.D.
Telephone Number	:	214-282-3188

Provider Enumeration Date	:	07/30/2013
Last Update Date	:	07/30/2013

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