Organization
NISHENDU M. VASAVADA, M.D., P.A.
Active
Organization
NISHENDU M. VASAVADA, M.D., P.A.
Active
Other names
Lakeside Life Center
Organization subpart
No
Provider details
NPI number
Authorized official
DEBBIE K. JOHNSON (OFFICE MANAGER)
(972) 221-1741
Entity
Organization
Contact information
Practice address
560 W MAIN ST, STE. 101, LEWISVILLE, TX 75057-3629
(972) 221-1741
(972) 219-0057
Mailing address
560 W MAIN ST, STE. 101, LEWISVILLE, TX 75057-3629
(972) 221-1741
(972) 219-0057
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
F2490
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0072MW
BLUE CROSS BLUE SHIELD
TX
05
—
200105540A
—
OK
05
—
220087501
—
TX
Enumeration date
03/20/2007
Last updated
08/03/2011
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