Basic Information
| Provider Information | |||||||||
| NPI: | 1497727382 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VENKATAPERUMAL | ||||||||
| FirstName: | SATISH | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5365 W ATLANTIC AVE | ||||||||
| Address2: | SUITE 504 | ||||||||
| City: | DELRAY BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334848172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5612419300 | ||||||||
| FaxNumber: | 5612419339 | ||||||||
| Practice Location | |||||||||
| Address1: | 4219 US HIGHWAY 19 | ||||||||
| Address2: | |||||||||
| City: | NEW PORT RICHEY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346525906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7279392230 | ||||||||
| FaxNumber: | 7278475349 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2006 | ||||||||
| LastUpdateDate: | 09/15/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | ME 80382 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 208VP0014X | ME80382 | FL | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 208VP0000X | ME80382 | FL | N | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 272482100 | 05 | FL | MEDICAID | 16063U | 01 | FL | MEDICARE PTAN 34259A | OTHER | 16063 | 01 | FL | BLUE CROSS INDIVIDUAL NUMBER | OTHER | 16063T | 01 | FL | MEDICARE 34259 | OTHER |