Provider Demographics
NPI:1073830832
Name:MOTHKUR, VENKAT K (MD)
Entity Type:Individual
Prefix:
First Name:VENKAT
Middle Name:K
Last Name:MOTHKUR
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 1:4411 MONTGOMERY RD
Mailing Address - Street 2:SUITE #206
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-3187
Mailing Address - Country:US
Mailing Address - Phone:513-977-6700
Mailing Address - Fax:
Practice Address - Street 1:4411 MONTGOMERY RD
Practice Address - Street 2:SUITE #206
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45212-3187
Practice Address - Country:US
Practice Address - Phone:513-977-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL03101982OtherDOB