Provider Demographics
NPI:1740266998
Name:NADIG, VISHWANATHA S (MD)
Entity type:Individual
Prefix:
First Name:VISHWANATHA
Middle Name:S
Last Name:NADIG
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 1:405 E COLLIN RAYE DR STE C
Mailing Address - Street 2:
Mailing Address - City:DE QUEEN
Mailing Address - State:AR
Mailing Address - Zip Code:71832-4107
Mailing Address - Country:US
Mailing Address - Phone:870-642-5323
Mailing Address - Fax:
Practice Address - Street 1:405 E COLLIN RAYE DR STE C
Practice Address - Street 2:
Practice Address - City:DE QUEEN
Practice Address - State:AR
Practice Address - Zip Code:71832
Practice Address - Country:US
Practice Address - Phone:870-642-5323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-34837207RI0011X
WV28667207RI0011X
VA0101268888207RI0011X
ARE-11030207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34689400Medicaid
KS200722890AMedicaid
MN314063600Medicaid
BN4181272OtherDEA
F94016Medicare UPIN
WI34689400Medicaid
MN314063600Medicaid