Provider Demographics
NPI:1598845919
Name:BANDI, VENKATA (MD)
Entity Type:Individual
Prefix:
First Name:VENKATA
Middle Name:
Last Name:BANDI
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 1:6620 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2348
Mailing Address - Country:US
Mailing Address - Phone:713-798-2500
Mailing Address - Fax:713-798-2505
Practice Address - Street 1:6620 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2348
Practice Address - Country:US
Practice Address - Phone:713-798-2500
Practice Address - Fax:713-798-2505
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8574207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130424803Medicaid
TX8AT557OtherBLUE CROSS BLUE SHIELD
TX300092993Medicare PIN
TX290010759Medicare PIN
E32915Medicare UPIN
TX130424803Medicaid
TX8B3931Medicare PIN
TX81J378Medicare PIN