Provider Demographics
NPI:1427026236
Name:PADEGAL, VIVEK A (MD)
Entity Type:Individual
Prefix:DR
First Name:VIVEK
Middle Name:A
Last Name:PADEGAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 117506
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75011-7506
Mailing Address - Country:US
Mailing Address - Phone:972-241-4208
Mailing Address - Fax:972-241-7189
Practice Address - Street 1:10 MEDICAL PKWY
Practice Address - Street 2:SUITE 301
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7840
Practice Address - Country:US
Practice Address - Phone:972-241-4208
Practice Address - Fax:972-241-7189
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4181207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0054288OtherBLUE LINK
TX44873002Medicaid
TX8B7952OtherBLUE CROSS/BLUE SHIELD
TX2900014771OtherRAILROAD MEDICARE
TX2143771OtherUNITED HEALTHCARE
TX2676528OtherAETNA
TX55374102OtherCIGNA
TX44873002Medicaid
TX8808J1Medicare PIN