Provider Demographics
NPI:1093717860
Name:VENKATARAMAN, MYTHILI T (MD)
Entity Type:Individual
Prefix:MRS
First Name:MYTHILI
Middle Name:T
Last Name:VENKATARAMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MYTHILI
Other - Middle Name:T
Other - Last Name:VENKATARAMANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5236 W UNIVERSITY DR
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-7889
Mailing Address - Country:US
Mailing Address - Phone:469-800-5450
Mailing Address - Fax:469-800-5455
Practice Address - Street 1:5236 W UNIVERSITY DR
Practice Address - Street 2:SUITE 2000
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-7889
Practice Address - Country:US
Practice Address - Phone:469-800-5450
Practice Address - Fax:469-800-5455
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101231606207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5861683Medicaid
290000276Medicare ID - Type Unspecified
VAVV1164AMedicare PIN
VA5861683Medicaid