Provider Demographics
NPI:1447690763
Name:SANKOORIKAL, VIVEK-THOMAS (MD)
Entity type:Individual
Prefix:
First Name:VIVEK-THOMAS
Middle Name:
Last Name:SANKOORIKAL
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:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:254-724-8800
Mailing Address - Fax:
Practice Address - Street 1:309 LAKE RD
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-1513
Practice Address - Country:US
Practice Address - Phone:254-933-5600
Practice Address - Fax:254-933-5605
Is Sole Proprietor?:No
Enumeration Date:2013-07-01
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS882-L207Q00000X
GA85214207Q00000X
TXR0493207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine