Provider Demographics
NPI:1104837889
Name:VYAS, NILESH (MD)
Entity Type:Individual
Prefix:DR
First Name:NILESH
Middle Name:
Last Name:VYAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:NILESH
Other - Middle Name:
Other - Last Name:VYAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:780 CLEAR LAKE CITY BLVD BLDG 2
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-5500
Mailing Address - Country:US
Mailing Address - Phone:281-464-8988
Mailing Address - Fax:281-464-7744
Practice Address - Street 1:780 CLEAR LAKE CITY BLVD BLDG 2
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-5500
Practice Address - Country:US
Practice Address - Phone:281-464-8988
Practice Address - Fax:281-464-7744
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4630207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX188609501Medicaid
TX8J4461Medicare PIN
TX188609501Medicaid