Provider Demographics
NPI:1043415250
Name:RAPURI, VENKAT RAGHAV (MD)
Entity Type:Individual
Prefix:
First Name:VENKAT
Middle Name:RAGHAV
Last Name:RAPURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 W RANDOL MILL RD STE 120
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-2579
Mailing Address - Country:US
Mailing Address - Phone:817-801-1503
Mailing Address - Fax:817-801-1508
Practice Address - Street 1:902 W RANDOL MILL RD STE 120
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2579
Practice Address - Country:US
Practice Address - Phone:817-801-1503
Practice Address - Fax:817-801-1508
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT184981207X00000X
DEC7-0003655207XP3100X
AZ41837207X00000X
OH35-095639208600000X
TXR0646207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ434488Medicaid
PAMT184981OtherMEDICAL LICENSE NUMBER
DEC7-0003655OtherMEDICAL LICENSE NUMBER
AZZ131109Medicare PIN