Provider Demographics
NPI:1780703942
Name:ATHI P VENKATESH MD PA
Entity type:Organization
Organization Name:ATHI P VENKATESH MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ATHI
Authorized Official - Middle Name:P
Authorized Official - Last Name:VENKATESH
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:281-358-5701
Mailing Address - Street 1:19701 KINGWOOD DR
Mailing Address - Street 2:BLDG 3
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-3773
Mailing Address - Country:US
Mailing Address - Phone:281-358-5701
Mailing Address - Fax:281-358-7061
Practice Address - Street 1:19701 KINGWOOD DR
Practice Address - Street 2:BLDG 3
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-3773
Practice Address - Country:US
Practice Address - Phone:281-358-5701
Practice Address - Fax:281-358-7061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176061302Medicaid
TX45D2077598OtherCLIA
TX45D2077598OtherCLIA