Provider Demographics
NPI:1194707406
Name:VASANDANI, JITENDRA I (MD)
Entity type:Individual
Prefix:DR
First Name:JITENDRA
Middle Name:I
Last Name:VASANDANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10705 MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-6153
Mailing Address - Country:US
Mailing Address - Phone:806-744-7223
Mailing Address - Fax:806-740-3325
Practice Address - Street 1:10705 MILWAUKEE AVENUE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:78424
Practice Address - Country:US
Practice Address - Phone:806-701-5210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9691207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100264101OtherFIRSTCARE
TX00680ROtherBCBS GROUP
TXCJ4139OtherRAILROAD MEDICARE
TX8445N3OtherBCBS
TX4637990001OtherMEDICARE NSC
TX040221603Medicaid
TXCJ4139OtherRAILROAD MEDICARE
TXH11828Medicare UPIN
TX040221603Medicaid
TX4637990001Medicare NSC