Provider Demographics
NPI:1760442750
Name:VICENTE, CHRIS MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:MICHAEL
Last Name:VICENTE
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 1:3523 MCKINNEY AVE
Mailing Address - Street 2:STE 735
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-1401
Mailing Address - Country:US
Mailing Address - Phone:214-703-1900
Mailing Address - Fax:214-703-1901
Practice Address - Street 1:1207 ARISTA DR
Practice Address - Street 2:STE 103
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-6657
Practice Address - Country:US
Practice Address - Phone:214-703-1900
Practice Address - Fax:214-703-1901
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME824752084N0400X
TXM34142084N0400X, 2084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264998500Medicaid
FL264998500Medicaid
FL62870AMedicare ID - Type Unspecified