Provider Demographics
NPI:1962592436
Name:KUTAGULA, VINAY (MD)
Entity type:Individual
Prefix:
First Name:VINAY
Middle Name:
Last Name:KUTAGULA
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 1:4708 ALLIANCE BLVD
Mailing Address - Street 2:PAV 1, SUITE 550
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5340
Mailing Address - Country:US
Mailing Address - Phone:469-800-6140
Mailing Address - Fax:469-800-6145
Practice Address - Street 1:4708 ALLIANCE BLVD
Practice Address - Street 2:PAV 1, SUITE 550
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5340
Practice Address - Country:US
Practice Address - Phone:469-800-6140
Practice Address - Fax:469-800-6145
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP2886207RH0002X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR154520001Medicaid
AR03120017500OtherQUALCHOICE
ARP00081865OtherRAILROAD MEDICARE1
AR5M729OtherBCBS
ARP00081865OtherRAILROAD MEDICARE1
H97699Medicare UPIN