Provider Demographics
NPI:1811181134
Name:LAMMATA, VISHU (MD)
Entity type:Individual
Prefix:
First Name:VISHU
Middle Name:
Last Name:LAMMATA
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 1:925 YORK DR
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2043
Mailing Address - Country:US
Mailing Address - Phone:972-572-1600
Mailing Address - Fax:972-572-2133
Practice Address - Street 1:925 YORK DR
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2043
Practice Address - Country:US
Practice Address - Phone:972-572-1600
Practice Address - Fax:972-572-2133
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1942207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122494104Medicaid
TX8AJ200OtherBCBS
TXC18112Medicare UPIN