Provider Demographics
NPI:1215248216
Name:VANGURU, INDIRA (MD)
Entity type:Individual
Prefix:
First Name:INDIRA
Middle Name:
Last Name:VANGURU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23920 KATY FWY
Mailing Address - Street 2:SUITE 500
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-1341
Mailing Address - Country:US
Mailing Address - Phone:281-391-5011
Mailing Address - Fax:
Practice Address - Street 1:MHMG, 23920 KATY FWY
Practice Address - Street 2:SUITE 500
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-1340
Practice Address - Country:US
Practice Address - Phone:281-391-5011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-24
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7366207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine