MEDICARE: MR. VICHA SIRI 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	207V00000X	Obstetrics & Gynecology Physician	G9805	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4057638	OTHER	TX	AETNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932176682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. VICHA SIRI MD

Provider Business Mailing Address
First Line	:	4325 N JOSEY LN
Second Line	:	STE 111
City	:	CARROLLTON
State	:	TX
Zip	:	75010-4636
Country	:	US
Telephone Number	:	972-492-5000
Fax Number	:	972-394-5909

Provider Business Practice Location Address
First Line	:	4325 N JOSEY LN
Second Line	:	STE 111
City	:	CARROLLTON
State	:	TX
Zip	:	75010-4635
Country	:	US
Telephone Number	:	972-492-5000
Fax Number	:	972-394-5909

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

Provider Enumeration Date	:	03/01/2006
Last Update Date	:	03/07/2016

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Directions to “ MR. VICHA SIRI MD” Practice Location

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