Provider Demographics
NPI:1427028372
Name:SREENARASIMHAIAH, VIJAYAPRAKASH (MD)
Entity Type:Individual
Prefix:DR
First Name:VIJAYAPRAKASH
Middle Name:
Last Name:SREENARASIMHAIAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:VIJAY
Other - Middle Name:
Other - Last Name:SREENARASIMHAIAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:915 GESSNER RD.
Mailing Address - Street 2:SUITE 360
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2527
Mailing Address - Country:US
Mailing Address - Phone:713-468-5440
Mailing Address - Fax:713-973-0778
Practice Address - Street 1:915 GESSNER RD.
Practice Address - Street 2:SUITE 360
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2527
Practice Address - Country:US
Practice Address - Phone:713-468-5440
Practice Address - Fax:713-973-0778
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9498174400000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1653248-02Medicaid
TX165324802Medicaid
TXH23834Medicare UPIN
TX165324802Medicaid