Basic Information
| Provider Information | |||||||||
| NPI: | 1942590955 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VIJAYAMADHAVAN | ||||||||
| FirstName: | VIVEK | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4807 PLATO PARK DR | ||||||||
| Address2: | |||||||||
| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774795373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8325327835 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6621 FANNIN ST | ||||||||
| Address2: | MC WT 6-104 ,SECTION OF NEONATOLOGY | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770302303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8328261380 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2011 | ||||||||
| LastUpdateDate: | 04/11/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080N0001X | N8740 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine |
No ID Information.