Provider Demographics
NPI:1932307295
Name:KRISHNASAMY, VENKATESH PERUMAL (MD)
Entity Type:Individual
Prefix:DR
First Name:VENKATESH
Middle Name:PERUMAL
Last Name:KRISHNASAMY
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:UAB DEPT OF RADIOLOGY 619 19TH ST SOUTH NHB H623
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35249-0001
Mailing Address - Country:US
Mailing Address - Phone:330-701-6765
Mailing Address - Fax:
Practice Address - Street 1:UAB DEPARTMENT OF RADIOLOGY 619 19TH ST SOUTH NHB H623
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35249-3609
Practice Address - Country:US
Practice Address - Phone:330-701-6765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA827472085R0204X
DCMD0405532085R0204X
CAA1262042085R0204X
NY3133422085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology