Provider Demographics
NPI:1639109358
Name:SLABISAK, VUDHI V (MD)
Entity Type:Individual
Prefix:
First Name:VUDHI
Middle Name:V
Last Name:SLABISAK
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 1:4090 MAPLESHADE LN STE 100
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-0025
Mailing Address - Country:US
Mailing Address - Phone:214-592-9955
Mailing Address - Fax:214-592-9935
Practice Address - Street 1:8861 COLEMAN BLVD
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-3209
Practice Address - Country:US
Practice Address - Phone:214-618-4675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8689207X00000X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135815215Medicaid
TX135815212Medicaid
TX135815213Medicaid
TX135815211Medicaid
TX135815212Medicaid
TXTXB122393Medicare PIN
TX135815213Medicaid
TXTXB122391Medicare PIN
TX8C1692Medicare PIN