Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | R3881 | TX |
NPI | 1023307808 |
---|---|
Provider Name | Dr. Vineel Kankanala |
First Address | Dallas, TX 75247-4228 |
Second Address | Desoto, TX 75115 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2011 |
Last Update Date | 23/09/2020 |