Provider Demographics
NPI:1568492387
Name:GIDVANI-DIAZ, VINOD KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:VINOD
Middle Name:KUMAR
Last Name:GIDVANI-DIAZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:42 SENDERO WOODS
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS RANCH
Mailing Address - State:TX
Mailing Address - Zip Code:78015-8370
Mailing Address - Country:US
Mailing Address - Phone:210-557-3172
Mailing Address - Fax:210-916-9319
Practice Address - Street 1:4410 MEDICAL DR
Practice Address - Street 2:STE 540
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3755
Practice Address - Country:US
Practice Address - Phone:210-916-7727
Practice Address - Fax:210-916-9319
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2016-11-14
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Provider Licenses
StateLicense IDTaxonomies
TXM72122080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology