Provider Demographics
NPI:1710939822
Name:A.VENKATESH,M.D.,INC
Entity Type:Organization
Organization Name:A.VENKATESH,M.D.,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAGIRISWAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:VENKATESH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-784-8442
Mailing Address - Street 1:4521 SHERMAN OAKS AVE
Mailing Address - Street 2:SUITE 1 B
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-3807
Mailing Address - Country:US
Mailing Address - Phone:818-784-8442
Mailing Address - Fax:818-784-8642
Practice Address - Street 1:4521 SHERMAN OAKS AVE
Practice Address - Street 2:SUITE 1 B
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-3807
Practice Address - Country:US
Practice Address - Phone:818-784-8442
Practice Address - Fax:818-784-8642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34195207RC0000X
CAA39371207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W12121Medicare ID - Type Unspecified