Provider Demographics
NPI:1063936854
Name:VETRIVEL VENKATASAMY, VIGHNESH (MD)
Entity type:Individual
Prefix:DR
First Name:VIGHNESH
Middle Name:
Last Name:VETRIVEL VENKATASAMY
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 1:31 SE 5TH ST APT 903
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-2506
Mailing Address - Country:US
Mailing Address - Phone:305-753-9644
Mailing Address - Fax:
Practice Address - Street 1:MIAMI TRANSPLANT INSTITUTE, JACKSON MEMORIAL HOSPITAL
Practice Address - Street 2:1611 NW 12 AVENUE
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136
Practice Address - Country:US
Practice Address - Phone:305-355-5000
Practice Address - Fax:305-355-5797
Is Sole Proprietor?:No
Enumeration Date:2017-08-02
Last Update Date:2020-09-22
Deactivation Date:2018-11-20
Deactivation Code:
Reactivation Date:2019-01-31
Provider Licenses
StateLicense IDTaxonomies
FLME145936204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery