Provider Demographics
NPI:1619073525
Name:IYER, VENKIT S (MD)
Entity Type:Individual
Prefix:DR
First Name:VENKIT
Middle Name:S
Last Name:IYER
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 1:4419 FALLBROOK BLVD
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-2653
Mailing Address - Country:US
Mailing Address - Phone:727-938-3804
Mailing Address - Fax:727-938-5625
Practice Address - Street 1:4419 FALLBROOK BLVD
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685-2653
Practice Address - Country:US
Practice Address - Phone:727-938-3804
Practice Address - Fax:727-938-5625
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL42021208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258592800Medicaid
FL21568YMedicare PIN