Provider Demographics
NPI:1649598285
Name:PANDEY, VIKAS
Entity type:Individual
Prefix:
First Name:VIKAS
Middle Name:
Last Name:PANDEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:VIKAS
Other - Middle Name:
Other - Last Name:PANDEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 678186
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-8186
Mailing Address - Country:US
Mailing Address - Phone:303-306-7783
Mailing Address - Fax:303-306-7753
Practice Address - Street 1:1717 MAIN ST STE 5850
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-7317
Practice Address - Country:US
Practice Address - Phone:972-449-0540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361552992084A2900X, 2084E0001X, 2084V0102X, 2084N0400X
TXQ37572084N0400X
MO20190423372084N0400X
CAA1591362084N0400X
WAMD615856362084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084A2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurocritical Care
No2084E0001XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyEpilepsy
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC81834OtherSOUTH CAROLINA MEDICAL LICENSE
AZ57634OtherARIZONA MEDICAL LICENSE
FLME120030OtherFLORIDA MEDICAL LICENSE
CA159136OtherCALIFORNIA MEDICAL LICENSE
GA84266OtherGEORGIA MEDICAL LICENSE
MO200092731Medicaid
OK32183OtherOKLAHOMA MEDICAL LICENSE
MI4301108260OtherMICHIGAN MEDICAL LICENSE
TXQ3757OtherTEXAS MEDICAL LICENSE
UT9730457-1205OtherUTAH MEDICAL LICENSE