Provider Demographics
NPI:1154313898
Name:GIYANANI, VISHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:VISHAN
Middle Name:
Last Name:GIYANANI
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 1:2415 E YANDELL DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79903-3616
Mailing Address - Country:US
Mailing Address - Phone:915-577-0111
Mailing Address - Fax:915-533-2568
Practice Address - Street 1:2415 E YANDELL DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-3616
Practice Address - Country:US
Practice Address - Phone:915-577-0111
Practice Address - Fax:915-533-2568
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG78132085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM77297Medicaid
1154313898OtherMEDICARE RR
TXMDG7813OtherWORKERS COMP
100900OtherSUPERIOR SSI
TX138569203Medicaid
TX300107708OtherMEDICARE RR
TX85614YOtherBCBS
GH05840081OtherEL PASO FIRST
TX61837OtherAMERIGROUP
NM00077297Medicaid
TX00U08WOtherBCBS
TX138569214Medicaid
54831OtherPRESBY MEDICAID
TX300061069OtherMEDICARE RR
TX61837OtherAMERIGROUP
TX300061069OtherMEDICARE RR
NM77297Medicaid
TX8F0143Medicare PIN
TX138569214Medicaid