Healthcare Provider Details

I. General information

NPI: 1689729568
Provider Name (Legal Business Name): VENU G PILLARISETTY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 08/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC ST BOX 356410
SEATTLE WA
98195-6410
US

IV. Provider business mailing address

1959 NE PACIFIC ST BOX 356410
SEATTLE WA
98195-6410
US

V. Phone/Fax

Practice location:
  • Phone: 206-616-4924
  • Fax: 206-543-8136
Mailing address:
  • Phone: 206-616-4924
  • Fax: 206-543-8136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number60096219
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: