Healthcare Provider Details

I. General information

NPI: 1447381728
Provider Name (Legal Business Name): VENKATESH NARAYAN NAGARADDI MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4716 RAVENDALE DR
RICHARDSON TX
75082-3835
US

IV. Provider business mailing address

4716 RAVENDALE DR
RICHARDSON TX
75082-3835
US

V. Phone/Fax

Practice location:
  • Phone: 972-860-9024
  • Fax: 972-525-8845
Mailing address:
  • Phone: 972-860-9024
  • Fax: 972-525-8845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD2019-0906
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number66290
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberM7461
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberDR.0062505
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number66290
License Number StateMN
# 6
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number036150686
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: