Provider Demographics
NPI:1316989023
Name:MAHENDRU, VIVEK (MD)
Entity type:Individual
Prefix:DR
First Name:VIVEK
Middle Name:
Last Name:MAHENDRU
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 1:4100 DUVAL RD BLDG III
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4275
Mailing Address - Country:US
Mailing Address - Phone:512-485-7200
Mailing Address - Fax:512-485-7220
Practice Address - Street 1:4100 DUVAL RD BLDG III
Practice Address - Street 2:SUITE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4275
Practice Address - Country:US
Practice Address - Phone:512-485-7200
Practice Address - Fax:512-485-7220
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7566174400000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84X790OtherBCBS
TX84X790OtherBCBS
TXG02659Medicare UPIN