Provider Demographics
NPI:1609356922
Name:KANAWADE, VAIBHAV (MD)
Entity Type:Individual
Prefix:
First Name:VAIBHAV
Middle Name:
Last Name:KANAWADE
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 1:2417 COLORADO ST APT 3202
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-3944
Mailing Address - Country:US
Mailing Address - Phone:210-702-7862
Mailing Address - Fax:
Practice Address - Street 1:910 S BRYAN RD STE 205
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6659
Practice Address - Country:US
Practice Address - Phone:210-709-4110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT2407207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery