Provider Demographics
NPI:1841501863
Name:ETHA, VENKATA SAI SHESHU KUMAR
Entity type:Individual
Prefix:DR
First Name:VENKATA SAI SHESHU
Middle Name:KUMAR
Last Name:ETHA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3190 E MIDLAND RD
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-2755
Mailing Address - Country:US
Mailing Address - Phone:989-667-6650
Mailing Address - Fax:989-667-6660
Practice Address - Street 1:3190 EAST MIDLAND ROAD
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706
Practice Address - Country:US
Practice Address - Phone:989-667-6650
Practice Address - Fax:989-667-6660
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301102600208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation