Provider Demographics
NPI:1730326158
Name:VENKAT, VASUKI N (MD)
Entity type:Individual
Prefix:
First Name:VASUKI
Middle Name:N
Last Name:VENKAT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20455 LORAIN RD
Mailing Address - Street 2:STE T01
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-3494
Mailing Address - Country:US
Mailing Address - Phone:440-799-4224
Mailing Address - Fax:440-799-4228
Practice Address - Street 1:27600 CHAGRIN BLVD STE 360
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:OH
Practice Address - Zip Code:44122-4498
Practice Address - Country:US
Practice Address - Phone:216-342-5795
Practice Address - Fax:216-342-5908
Is Sole Proprietor?:No
Enumeration Date:2009-01-08
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35099499207RN0300X
CAA103763207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH75338Medicaid