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General NPI Number Information
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NPI Number | 1053604827
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Entity Type | Organization
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Legal Business Name | KATHARIGUPPA VENKATARAM M.D. P.A.
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Dates
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Enumeration Date | 05/26/2011
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Last Update Date | 12/05/2011
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Provider Practice Location Address
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Address Line | 208 CRYSTAL GROVE BLVD
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City | LUTZ
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State | FL
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Zip | 33548-6460
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Country | US
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Telephone | 813-949-4991
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Fax | 813-949-4986
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Provider Business Mailing Address
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Address Line | 208 CRYSTAL GROVE BLVD
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City | LUTZ
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State | FL
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Zip | 33548-6460
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Country | US
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Telephone | 813-949-4991
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Fax | 813-949-4986
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. KATHARIGUPPA VENKATARAM
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Credential | M.D
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Telephone | 813-949-4991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME73717
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License Number State | FL
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