Provider Demographics
NPI: | 1669573598 |
---|---|
Name: | THOLAKANAHALLI, VENKATAKRISHNA NARASIMHAMURTHY (MBBS) |
Entity type: | Individual |
Prefix: | DR |
First Name: | VENKATAKRISHNA |
Middle Name: | NARASIMHAMURTHY |
Last Name: | THOLAKANAHALLI |
Suffix: | |
Gender: | M |
Credentials: | MBBS |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 111C ONE VETERANS DRIVE |
Mailing Address - Street 2: | |
Mailing Address - City: | MINNEAPOLIS |
Mailing Address - State: | MN |
Mailing Address - Zip Code: | 55417-2309 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 612-467-3662 |
Mailing Address - Fax: | 612-727-5668 |
Practice Address - Street 1: | 111C, ONE VETERANS DR. |
Practice Address - Street 2: | |
Practice Address - City: | MINNEAPOLIS |
Practice Address - State: | MN |
Practice Address - Zip Code: | 55417-2309 |
Practice Address - Country: | US |
Practice Address - Phone: | 612-467-3662 |
Practice Address - Fax: | 612-727-5668 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-09-25 |
Last Update Date: | 2025-02-12 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
ND | 8054 | 207RC0000X, 207RC0001X |
MN | 56128 | 207RC0000X, 207RC0001X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RC0001X | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |