Provider Demographics
NPI:1063413904
Name:RAMAIAH, VENKATESH G (MD)
Entity type:Individual
Prefix:
First Name:VENKATESH
Middle Name:G
Last Name:RAMAIAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7285 E EARLL DR BLDG C
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-7230
Mailing Address - Country:US
Mailing Address - Phone:480-912-4747
Mailing Address - Fax:480-422-2690
Practice Address - Street 1:7285 E EARLL DR BLDG C
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-7230
Practice Address - Country:US
Practice Address - Phone:480-912-4747
Practice Address - Fax:480-422-2690
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ251252086S0129X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ770002895OtherRAILROAD MEDICARE
AZ386038Medicaid
AZWCSKQOtherSUN HEALTH GROUP #
AZG51638Medicare UPIN
AZWCSKQOtherSUN HEALTH GROUP #