Provider Demographics
NPI:1861604191
Name:VANIK, RICHARD KENNETH (MD,JD)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:KENNETH
Last Name:VANIK
Suffix:
Gender:M
Credentials:MD,JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 SOUTHWEST FWY STE 500
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1811
Mailing Address - Country:US
Mailing Address - Phone:713-981-7900
Mailing Address - Fax:713-774-5119
Practice Address - Street 1:7777 SOUTHWEST FWY STE 500
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1811
Practice Address - Country:US
Practice Address - Phone:713-981-7900
Practice Address - Fax:713-774-5119
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7365174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114152502Medicaid
TX161997156OtherTAX ID ASSOCIATED NPI NUM
TX161997156OtherTAX ID ASSOCIATED NPI NUM
TXC22920Medicare UPIN