Provider Demographics
NPI:1598959967
Name:GONUGUNTLA, VEENA V (MD)
Entity Type:Individual
Prefix:DR
First Name:VEENA
Middle Name:V
Last Name:GONUGUNTLA
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 1:600 WALNUT RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53029-9385
Mailing Address - Country:US
Mailing Address - Phone:262-369-7040
Mailing Address - Fax:262-369-7041
Practice Address - Street 1:600 WALNUT RIDGE DR
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:WI
Practice Address - Zip Code:53029-9385
Practice Address - Country:US
Practice Address - Phone:262-369-7040
Practice Address - Fax:262-369-7041
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI52522-20208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1598959967Medicaid
WIGONUGVEEOtherMERCYCARE INSURANCE
WI1598959967Medicaid