MEDICARE: DR. MEENA VENUGOPAL 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	207Q00000X	Family Medicine Physician	30137	AZ

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

General Provider Information

NPI Number	:	1588674832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MEENA VENUGOPAL MD

Provider Business Mailing Address
First Line	:	PO BOX 35380
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-5380
Country	:	US
Telephone Number	:	702-579-3203
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 S DOBSON RD STE 100
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85286-6158
Country	:	US
Telephone Number	:	480-347-4300
Fax Number	:	480-347-4360

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

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	07/11/2023

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