Provider Demographics
NPI:1972969640
Name:VKN HEALTH SERVICES PLLC
Entity Type:Organization
Organization Name:VKN HEALTH SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRAGEYI
Authorized Official - Middle Name:
Authorized Official - Last Name:BANDARU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-873-5184
Mailing Address - Street 1:1619 BOX CANYON CT
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-4719
Mailing Address - Country:US
Mailing Address - Phone:614-873-5184
Mailing Address - Fax:
Practice Address - Street 1:1619 BOX CANYON CT
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-4719
Practice Address - Country:US
Practice Address - Phone:614-873-5184
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ2734207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty