Organization
DIABETES AND GLANDULAR DISEASE CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACOB VADAKEKALAM MD (PRESIDENT)
(210) 615-5541
Entity
Organization
Contact information
Practice address
5107 MEDICAL DR, SAN ANTONIO, TX 78229
(210) 614-8612
(210) 615-5596
Mailing address
5107 MEDICAL DR, SAN ANTONIO, TX 78229
(210) 614-8612
(210) 615-5596
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
121762202
—
TX
Enumeration date
08/29/2006
Last updated
06/09/2022
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