Provider Demographics
NPI:1255502506
Name:VENUGOPAL, ANILRUDH (MD)
Entity Type:Individual
Prefix:
First Name:ANILRUDH
Middle Name:
Last Name:VENUGOPAL
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 1:9301 OAKDALE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-6538
Mailing Address - Country:US
Mailing Address - Phone:818-336-4952
Mailing Address - Fax:949-224-1495
Practice Address - Street 1:9301 OAKDALE AVE STE 200
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-6538
Practice Address - Country:US
Practice Address - Phone:818-336-4952
Practice Address - Fax:949-224-1495
Is Sole Proprietor?:No
Enumeration Date:2008-03-14
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.115326207RI0200X
CAC56059207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM71670Medicare PIN