Provider Demographics
NPI:1154359768
Name:RAJARAM, VENKATRAM (MD,)
Entity type:Individual
Prefix:DR
First Name:VENKATRAM
Middle Name:
Last Name:RAJARAM
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:DR
Other - First Name:VENKATARAMAN
Other - Middle Name:
Other - Last Name:RAJARAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD,
Mailing Address - Street 1:PO BOX 8043
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73083-8043
Mailing Address - Country:US
Mailing Address - Phone:405-622-3063
Mailing Address - Fax:888-248-6861
Practice Address - Street 1:105 S BRYANT AVE STE 101
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034
Practice Address - Country:US
Practice Address - Phone:405-622-3063
Practice Address - Fax:405-732-0022
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036101739207R00000X
OK28679207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH21518Medicare UPIN