Provider Demographics
NPI:1720027154
Name:KAVADI, VIVEK SHARAD (MD)
Entity Type:Individual
Prefix:DR
First Name:VIVEK
Middle Name:SHARAD
Last Name:KAVADI
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:1350 FIRST COLONY BLVD
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-4308
Practice Address - Country:US
Practice Address - Phone:281-277-5200
Practice Address - Fax:281-276-3492
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH57802085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX40627401Medicaid
TX132603507Medicaid
TX132603510Medicaid
TX8R1483OtherBLUE CROSS OF TX
TX132603508Medicaid
TX132603506Medicaid
TX132603511Medicaid
TX8C7586Medicare PIN
TXF81475Medicare UPIN
TX132603506Medicaid
TXP00165387Medicare PIN
TX8R1483OtherBLUE CROSS OF TX
TX40627401Medicaid
TX132603508Medicaid
TX132603507Medicaid