Provider Demographics
NPI:1104956119
Name:MENON, DILEEP VIJAY (MD)
Entity type:Individual
Prefix:DR
First Name:DILEEP
Middle Name:VIJAY
Last Name:MENON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4449
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-4449
Mailing Address - Country:US
Mailing Address - Phone:563-623-5214
Mailing Address - Fax:956-362-3521
Practice Address - Street 1:101 N FM 3167 STE 104
Practice Address - Street 2:
Practice Address - City:RIO GRANDE CITY
Practice Address - State:TX
Practice Address - Zip Code:78582-6776
Practice Address - Country:US
Practice Address - Phone:956-352-1431
Practice Address - Fax:956-352-1436
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3018207R00000X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX285658501Medicaid
TXTXB137622Medicare PIN