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General NPI Number Information
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NPI Number | 1952764268
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Entity Type | Individual
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Provider Name | VENKATA KISHORE REDDY MUKKU M.D
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Gender | Male
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Dates
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Enumeration Date | 04/04/2016
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Last Update Date | 08/27/2024
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Provider Practice Location Address
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Address Line | 6300 W PARKER RD STE 224
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City | PLANO
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State | TX
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Zip | 75093-8102
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Country | US
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Telephone | 469-574-0464
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Fax |
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Provider Business Mailing Address
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Address Line | 1600 WATERS RIDGE DR STE A
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City | LEWISVILLE
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State | TX
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Zip | 75057-6039
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Country | US
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Telephone | 972-219-0558
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Fax |
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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 | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | S0749
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | S0749
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License Number State | TX
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