Provider Demographics
NPI:1780025437
Name:DURGA P. VEDATI, MDPA
Entity Type:Organization
Organization Name:DURGA P. VEDATI, MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DURGA
Authorized Official - Middle Name:PRASAD
Authorized Official - Last Name:VEDATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-787-6266
Mailing Address - Street 1:PO BOX 92994
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-0994
Mailing Address - Country:US
Mailing Address - Phone:248-787-6266
Mailing Address - Fax:817-993-1437
Practice Address - Street 1:611 N MACARTHUR BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-7423
Practice Address - Country:US
Practice Address - Phone:248-787-6266
Practice Address - Fax:817-993-1437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-10
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN2331207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty