MEDICARE: DR. VENKATA KISHORE REDDY MUKKU M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	S0749	TX
2	207RN0300X	Nephrology Physician	S0749	TX

General Provider Information

NPI Number	:	1952764268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VENKATA KISHORE REDDY MUKKU M.D

Provider Business Mailing Address
First Line	:	1600 WATERS RIDGE DR STE A
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75057-6039
Country	:	US
Telephone Number	:	972-219-0558
Fax Number	:

Provider Business Practice Location Address
First Line	:	6300 W PARKER RD STE 224
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-8102
Country	:	US
Telephone Number	:	469-574-0464
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2016
Last Update Date	:	01/20/2026

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