Provider Demographics
NPI:1194031633
Name:VIJAYA KAVIKONDALA MD PA
Entity Type:Organization
Organization Name:VIJAYA KAVIKONDALA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VIJAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAVIKONDALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-804-4936
Mailing Address - Street 1:4557 KENTUCKY DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3984
Mailing Address - Country:US
Mailing Address - Phone:972-491-0795
Mailing Address - Fax:972-491-0795
Practice Address - Street 1:4557 KENTUCKY DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3984
Practice Address - Country:US
Practice Address - Phone:972-491-0795
Practice Address - Fax:972-491-0795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-22
Last Update Date:2010-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2666207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty