Healthcare Provider Details

I. General information

NPI: 1720565831
Provider Name (Legal Business Name): VENKATA SIVA KUMAR PAJJURU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2018
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 W 8TH ST
YANKTON SD
57078-3306
US

IV. Provider business mailing address

1104 W 8TH ST
YANKTON SD
57078-3306
US

V. Phone/Fax

Practice location:
  • Phone: 605-665-7841
  • Fax: 605-665-8337
Mailing address:
  • Phone: 605-665-7841
  • Fax: 605-665-8337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number14435
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: