Provider Demographics
NPI:1063463974
Name:VENKATESH, SRINIVASA RAO (MD)
Entity Type:Individual
Prefix:DR
First Name:SRINIVASA
Middle Name:RAO
Last Name:VENKATESH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SRINIVASA
Other - Middle Name:RAO
Other - Last Name:VENKATESH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:10425 HUFFMEISTER RD STE 340
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-3429
Mailing Address - Country:US
Mailing Address - Phone:281-807-7676
Mailing Address - Fax:281-807-6888
Practice Address - Street 1:10425 HUFFMEISTER RD STE 340
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-3429
Practice Address - Country:US
Practice Address - Phone:281-807-7676
Practice Address - Fax:281-807-6888
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2023-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2876174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX037815002Medicaid
TXTXB161700Medicare PIN
TX037815002Medicaid