Provider Demographics
NPI:1417974122
Name:JAISWAL, VILKESH RAMANLAL (MD)
Entity Type:Individual
Prefix:
First Name:VILKESH
Middle Name:RAMANLAL
Last Name:JAISWAL
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 1:14275 MIDWAY RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3614
Mailing Address - Country:US
Mailing Address - Phone:214-932-8029
Mailing Address - Fax:610-271-4245
Practice Address - Street 1:1401 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2113
Practice Address - Country:US
Practice Address - Phone:817-878-5637
Practice Address - Fax:817-878-5698
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8918207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150996004Medicaid
TXP00292106OtherRAILROAD MEDICARE
TX8S9691OtherBCBS
TX8D7900Medicare ID - Type UnspecifiedLOCALITY 28
TXH71314Medicare UPIN