Provider Demographics
NPI:1336530427
Name:VIKRAM VADYALA PLLC
Entity Type:Organization
Organization Name:VIKRAM VADYALA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:VIKRAM
Authorized Official - Middle Name:REDDY
Authorized Official - Last Name:VADYALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:432-686-9999
Mailing Address - Street 1:2002 N MIDLAND DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-5598
Mailing Address - Country:US
Mailing Address - Phone:432-686-9999
Mailing Address - Fax:432-685-1700
Practice Address - Street 1:2002 N MIDLAND DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-5598
Practice Address - Country:US
Practice Address - Phone:432-686-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-10
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP2073207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty