Basic Information
| Provider Information | |||||||||
| NPI: | 1659378305 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SETHURAMAN | ||||||||
| FirstName: | VENKAT | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3450 FOREST LN STE 200 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752347714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727417189 | ||||||||
| FaxNumber: | 2146141448 | ||||||||
| Practice Location | |||||||||
| Address1: | 3450 FOREST LN STE 200 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752347714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727417189 | ||||||||
| FaxNumber: | 2144847568 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2005 | ||||||||
| LastUpdateDate: | 05/10/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0117X | N6010 | TX | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine |
ID Information
| ID | Type | State | Issuer | Description | N6010 | 01 | TX | MEDICAL LICENSE | OTHER |