Provider Demographics
NPI:1083671796
Name:VENKATESH, PURNIMA (MD)
Entity Type:Individual
Prefix:DR
First Name:PURNIMA
Middle Name:
Last Name:VENKATESH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 CENTRAL PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-6111
Mailing Address - Country:US
Mailing Address - Phone:817-571-6622
Mailing Address - Fax:817-868-1962
Practice Address - Street 1:2305 CENTRAL PARK BLVD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6111
Practice Address - Country:US
Practice Address - Phone:817-571-6622
Practice Address - Fax:817-868-1962
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9446207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82392SOtherBC/BS
TX7010260OtherAETNA
TX7010260OtherAETNA
TXH37345Medicare UPIN