MEDICARE: NAREN NATRAJ VENKATESAN MD

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	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	A131477	CA
2	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	Q5595	TX
3	207Y00000X	Otolaryngology Physician	Q5595	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	8FK539	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1346484318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAREN NATRAJ VENKATESAN MD

Provider Business Mailing Address
First Line	:	3600 GASTON AVE STE 502
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75246-1805
Country	:	US
Telephone Number	:	469-800-7700
Fax Number	:	469-800-7710

Provider Business Practice Location Address
First Line	:	3600 GASTON AVE STE 502
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75246-1805
Country	:	US
Telephone Number	:	469-800-7700
Fax Number	:	469-800-7710

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

Provider Enumeration Date	:	04/21/2009
Last Update Date	:	02/03/2020

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Directions to “ NAREN NATRAJ VENKATESAN MD” Practice Location

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