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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