Provider Demographics
NPI:1114144961
Name:VINDEKILDE, SOREN JOHN (MD)
Entity Type:Individual
Prefix:
First Name:SOREN
Middle Name:JOHN
Last Name:VINDEKILDE
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 1:4600 GULF FWY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77023-3548
Mailing Address - Country:US
Mailing Address - Phone:713-831-6554
Mailing Address - Fax:713-535-2554
Practice Address - Street 1:4600 GULF FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77023-3548
Practice Address - Country:US
Practice Address - Phone:713-831-6554
Practice Address - Fax:713-535-2554
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2877207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTPI107554101Medicaid