Provider Demographics
NPI:1447332457
Name:PANCHAMUKHI, VARADENDRA B (MD)
Entity type:Individual
Prefix:
First Name:VARADENDRA
Middle Name:B
Last Name:PANCHAMUKHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8440 WALNUT HILL LN STE 700
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-3824
Mailing Address - Country:US
Mailing Address - Phone:214-361-3300
Mailing Address - Fax:214-361-3353
Practice Address - Street 1:4510 MEDICAL CENTER DR STE 108
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-1624
Practice Address - Country:US
Practice Address - Phone:214-726-9292
Practice Address - Fax:214-361-3431
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-100960174400000X
IL036100960207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No174400000XOther Service ProvidersSpecialist
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL060070688OtherRAILROAD
IL036100960Medicaid
IL036100960Medicaid
IL214881Medicare Oscar/Certification
ILH76785Medicare UPIN