MEDICARE: DR. PAOLO V. VENEGONI 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	207RI0011X	Interventional Cardiology Physician	J3645	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	060064377	OTHER	TX	MEDICARE RAILROAD

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790771814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAOLO V. VENEGONI MD

Provider Business Mailing Address
First Line	:	5301 RIATA PARK CT
Second Line	:	BLDG D SUITE 200
City	:	AUSTIN
State	:	TX
Zip	:	78727-3437
Country	:	US
Telephone Number	:	512-617-6000
Fax Number	:	512-615-0459

Provider Business Practice Location Address
First Line	:	2200 PARK BEND DR
Second Line	:	BLDG 2 STE. 300
City	:	AUSTIN
State	:	TX
Zip	:	78758-5387
Country	:	US
Telephone Number	:	512-617-6000
Fax Number	:	512-339-7838

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

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	01/27/2022

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