MEDICARE: DR. RAJI VENKAT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	8906	NV

General Provider Information

NPI Number	:	1093712986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAJI VENKAT M.D.

Provider Business Mailing Address
First Line	:	PO BOX 33269
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85067-3269
Country	:	US
Telephone Number	:	602-406-4786
Fax Number	:	916-636-4358

Provider Business Practice Location Address
First Line	:	10001 S EASTERN AVE STE 101
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-3908
Country	:	US
Telephone Number	:	702-616-5870
Fax Number	:	702-616-5895

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	10/30/2024

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