Provider Demographics
NPI:1528360021
Name:IPE, GEORGE VINU (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:VINU
Last Name:IPE
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 1:3417 GASTON AVE
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-2016
Mailing Address - Country:US
Mailing Address - Phone:469-800-9000
Mailing Address - Fax:469-800-9140
Practice Address - Street 1:3417 GASTON AVE
Practice Address - Street 2:SUITE 1100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2016
Practice Address - Country:US
Practice Address - Phone:469-800-9000
Practice Address - Fax:469-800-9140
Is Sole Proprietor?:No
Enumeration Date:2010-12-03
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036126753208M00000X
TXQ2304207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP01021495OtherRAILROAD MEDICARE PTAN
TX3467490-03Medicaid
IL036126753Medicaid
TX3467490-03Medicaid
ILP01021495OtherRAILROAD MEDICARE PTAN