Basic Information
| Provider Information | |||||||||
| NPI: | 1548228638 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SRINIVASAN | ||||||||
| FirstName: | VENKATESAN | ||||||||
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| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8201 EWING HALSELL DR | ||||||||
| Address2: | 280 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782293743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105758500 | ||||||||
| FaxNumber: | 2105758506 | ||||||||
| Practice Location | |||||||||
| Address1: | 7700 FLOYD CURL | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782293979 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105758500 | ||||||||
| FaxNumber: | 2105758506 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | G6022 | TX | X | Allopathic & Osteopathic Physicians | Pediatrics | 208G00000X | G6022 | TX | X | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
No ID Information.