Provider Demographics
NPI:1528528114
Name:VIJI PRADEEP KODUVATH PLLC
Entity type:Organization
Organization Name:VIJI PRADEEP KODUVATH PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:
Authorized Official - Last Name:TEMPLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-757-2902
Mailing Address - Street 1:1837 N GARLAND AVE
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-4561
Mailing Address - Country:US
Mailing Address - Phone:469-432-4107
Mailing Address - Fax:
Practice Address - Street 1:1837 N GARLAND AVE
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-4561
Practice Address - Country:US
Practice Address - Phone:469-432-4107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-21
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty