Vontivillu, Gayathri S
Vontivillu, Gayathri S is an individual health care provider with primary practice located at 1901 N Macarthur Blvd , Irving TX 75061-2220. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Hospitalist. Allopathic & Osteopathic Physicians / Internal Medicine is her primary health care specialty. Vontivillu, Gayathri S can be contacted via phone (972) 579-8485.Contact Information
Primary practice address
1901 N Macarthur Blvd
Irving TX 75061-2220
Phone: (972) 579-8485
Fax: (972) 579-3972
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 4301071781 | Michigan |
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | N5463 | Texas |
| Allopathic & Osteopathic Physicians / Hospitalist | 208M00000X | N5463 | Texas |
Profile Details
| NPI number | 1043291321 |
|---|---|
| LBN Legal business name | Vontivillu, Gayathri S |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 14th, 2005 |
| Last updated | Jul 6th, 2012 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1043291321 | NPPES |
| Texas | MEDICAID | 217372601 | |
| Texas | Other | 8CL601 |
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