Provider Demographics
NPI:1952764268
Name:MUKKU, VENKATA KISHORE REDDY (MD)
Entity type:Individual
Prefix:DR
First Name:VENKATA KISHORE
Middle Name:REDDY
Last Name:MUKKU
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 1:1600 WATERS RIDGE DR STE A
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-6039
Mailing Address - Country:US
Mailing Address - Phone:972-219-0558
Mailing Address - Fax:
Practice Address - Street 1:6300 W PARKER RD STE 224
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8102
Practice Address - Country:US
Practice Address - Phone:469-574-0464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-04
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS0749207RN0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology