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General NPI Number Information
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NPI Number | 1578851572
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Entity Type | Individual
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Provider Name | PAVAN KUMAR TENNETI VENKATA MD
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Gender | Male
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Dates
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Enumeration Date | 07/12/2011
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 13041 N DEL WEBB BLVD SUITE 200
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City | SUN CITY
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State | AZ
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Zip | 85351
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Country | US
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Telephone | 623-832-0300
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Fax | 623-285-2801
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Provider Business Mailing Address
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Address Line | 13041 N DEL WEBB BLVD SUITE 200
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City | SUN CITY
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State | AZ
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Zip | 85351
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Country | US
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Telephone | 623-832-0300
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Fax | 623-285-2801
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2019-00568
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | ME156097
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 49297
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License Number State | AZ
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