Provider Demographics
NPI:1649598285
Name:PANDEY, VIKAS
Entity Type:Individual
Prefix:
First Name:VIKAS
Middle Name:
Last Name:PANDEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:VIKAS
Other - Middle Name:
Other - Last Name:PANDEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 678186
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-8186
Mailing Address - Country:US
Mailing Address - Phone:303-306-7783
Mailing Address - Fax:303-306-7753
Practice Address - Street 1:1717 MAIN ST STE 5850
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-7317
Practice Address - Country:US
Practice Address - Phone:972-449-0540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20190423372084N0400X
TXQ37572084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT9730457-1205OtherUTAH MEDICAL LICENSE
CA159136OtherCALIFORNIA MEDICAL LICENSE
AZ57634OtherARIZONA MEDICAL LICENSE
GA84266OtherGEORGIA MEDICAL LICENSE
FLME120030OtherFLORIDA MEDICAL LICENSE
OK32183OtherOKLAHOMA MEDICAL LICENSE
SC81834OtherSOUTH CAROLINA MEDICAL LICENSE
TXQ3757OtherTEXAS MEDICAL LICENSE
MI4301108260OtherMICHIGAN MEDICAL LICENSE
MO200092731Medicaid