Healthcare Provider Details

I. General information

NPI: 1093717860
Provider Name (Legal Business Name): MYTHILI T VENKATARAMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MYTHILI T VENKATARAMANI

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 05/22/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4716 ALLIANCE BLVD SUITE 700
PLANO TX
75093
US

IV. Provider business mailing address

4716 ALLIANCE BLVD SUITE 700
PLANO TX
75093
US

V. Phone/Fax

Practice location:
  • Phone: 469-800-6000
  • Fax: 469-800-6030
Mailing address:
  • Phone: 469-800-6000
  • Fax: 469-800-6030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number0101231606
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: