MEDICARE: KIRAN SETHI VENINCASA 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	208600000X	Surgery Physician	T0031	TX

General Provider Information

NPI Number	:	1821477274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRAN SETHI VENINCASA M.D.

Provider Business Mailing Address
First Line	:	4450 TUBBS RD
Second Line	:
City	:	ROCKWALL
State	:	TX
Zip	:	75032-6308
Country	:	US
Telephone Number	:	972-722-3290
Fax Number	:	469-402-2585

Provider Business Practice Location Address
First Line	:	2001 N MACARTHUR BLVD STE 700
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75061-2204
Country	:	US
Telephone Number	:	469-800-1300
Fax Number	:

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

Provider Enumeration Date	:	05/19/2015
Last Update Date	:	06/01/2026

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