Provider Demographics
NPI:1831385137
Name:LELE, EKNATH VINAYAK (MD)
Entity type:Individual
Prefix:DR
First Name:EKNATH
Middle Name:VINAYAK
Last Name:LELE
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 1:1605 BEAR CREEK DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-4893
Mailing Address - Country:US
Mailing Address - Phone:432-758-6214
Mailing Address - Fax:
Practice Address - Street 1:1004-HOBBS HWY SUITE4
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:TX
Practice Address - Zip Code:79360-0000
Practice Address - Country:US
Practice Address - Phone:432-758-6214
Practice Address - Fax:432-758-6214
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE-1888208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB24340Medicare UPIN