Provider Demographics
NPI:1073858106
Name:SRI VENKAT PLLC
Entity Type:Organization
Organization Name:SRI VENKAT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARICHANDANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUKKAMALLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-688-3433
Mailing Address - Street 1:6512 DESEO
Mailing Address - Street 2:APT 126
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-3227
Mailing Address - Country:US
Mailing Address - Phone:817-688-3433
Mailing Address - Fax:214-723-7650
Practice Address - Street 1:6512 DESEO
Practice Address - Street 2:APT 126
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-3227
Practice Address - Country:US
Practice Address - Phone:817-688-3433
Practice Address - Fax:214-723-7650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3914207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty