Healthcare Provider Details

I. General information

NPI: 1982161519
Provider Name (Legal Business Name): ANISH VENKAT RAMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2019
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 MEDICAL PKWY STE 320
AUSTIN TX
78705-1023
US

IV. Provider business mailing address

3705 MEDICAL PKWY STE 320
AUSTIN TX
78705-1023
US

V. Phone/Fax

Practice location:
  • Phone: 512-454-1873
  • Fax: 512-371-7098
Mailing address:
  • Phone: 512-454-0392
  • Fax: 512-454-1233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberU9066
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: