Provider Demographics
NPI:1902544356
Name:VENKATARAMANAN, AKASH (MBBS)
Entity Type:Individual
Prefix:
First Name:AKASH
Middle Name:
Last Name:VENKATARAMANAN
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 W POLK STREET
Mailing Address - Street 2:#6142
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612
Mailing Address - Country:US
Mailing Address - Phone:312-864-7311
Mailing Address - Fax:312-864-9725
Practice Address - Street 1:1969 W OGDEN AVENUE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-864-7311
Practice Address - Fax:312-864-9725
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL125079514207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program