Individual
DR. VENKATESAN DYANESH VIDI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., M.P.H.
Contact information
Practice address
1305 AIRPORT FWY STE 424, BEDFORD, TX 76021-6608
(817) 510-1060
Mailing address
1615 PRECINCT LINE RD STE 103, HURST, TX 76054-3345
(181) 771-6014
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
273680
NY
207RC0000X
Cardiovascular Disease Physician
273680
NY
207RI0011X
Interventional Cardiology Physician
Primary
273680
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3520546
—
TX
01
—
441463
MEDICARE PTAN
TX
Enumeration date
03/13/2008
Last updated
03/24/2022
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