MEDICARE: DR. KALIYUR G. VENKATARAMANA 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	166883	NY

General Provider Information

NPI Number	:	1790870814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KALIYUR G. VENKATARAMANA M.D.

Provider Business Mailing Address
First Line	:	122 FULTON ST
Second Line	:	4TH FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10038-2717
Country	:	US
Telephone Number	:	212-227-3670
Fax Number	:	212-227-3693

Provider Business Practice Location Address
First Line	:	122 FULTON ST
Second Line	:	4TH FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10038-2717
Country	:	US
Telephone Number	:	212-227-3670
Fax Number	:	212-227-3693

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	07/08/2007

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