Provider Demographics
NPI:1932115433
Name:VENKATRAM, SHYAMALA (MD)
Entity Type:Individual
Prefix:MS
First Name:SHYAMALA
Middle Name:
Last Name:VENKATRAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:SHYAMALA
Other - Middle Name:
Other - Last Name:RAJOGYPOLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1400 S POTOMAC ST
Mailing Address - Street 2:STE 110
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-4528
Mailing Address - Country:US
Mailing Address - Phone:303-745-0000
Mailing Address - Fax:303-745-1299
Practice Address - Street 1:1400 S POTOMAC ST
Practice Address - Street 2:STE 110
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4528
Practice Address - Country:US
Practice Address - Phone:303-745-0000
Practice Address - Fax:303-745-1299
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39418207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F95360Medicare UPIN
CO68583001Medicare ID - Type Unspecified
C800940Medicare ID - Type Unspecified