Provider Demographics
NPI:1932176682
Name:SIRI, VICHA (MD)
Entity Type:Individual
Prefix:MR
First Name:VICHA
Middle Name:
Last Name:SIRI
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 1:4325 N JOSEY LN
Mailing Address - Street 2:STE 111
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4636
Mailing Address - Country:US
Mailing Address - Phone:972-492-5000
Mailing Address - Fax:972-394-5909
Practice Address - Street 1:4325 N JOSEY LN
Practice Address - Street 2:STE 111
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4635
Practice Address - Country:US
Practice Address - Phone:972-492-5000
Practice Address - Fax:972-394-5909
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9805207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4057638OtherAETNA
TX097524501Medicaid
TXC21870Medicare UPIN
TX097524501Medicaid