Provider Demographics
NPI:1497724892
Name:MURTHY, VENKATA K (MD)
Entity Type:Individual
Prefix:
First Name:VENKATA
Middle Name:K
Last Name:MURTHY
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 1:400 4TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:SLEEPY EYE
Mailing Address - State:MN
Mailing Address - Zip Code:56085-1109
Mailing Address - Country:US
Mailing Address - Phone:507-794-3691
Mailing Address - Fax:507-794-5950
Practice Address - Street 1:400 4TH AVE NW
Practice Address - Street 2:
Practice Address - City:SLEEPY EYE
Practice Address - State:MN
Practice Address - Zip Code:56085-1109
Practice Address - Country:US
Practice Address - Phone:507-794-3691
Practice Address - Fax:507-794-5950
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN20403207Q00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN470775300Medicaid
1710218OtherMEDICA
MR9121013534OtherPREFERRED ONE
114060OtherUCARE
020052315OtherMEDICARE RAILROAD
5888298OtherAETNA
52665MUOtherMPIN
MR9121013534OtherPREFERRED ONE
MN470775300Medicaid