Provider Demographics
NPI:1932202546
Name:LUTHRA, VENU KUMAR (MD)
Entity type:Individual
Prefix:DR
First Name:VENU
Middle Name:KUMAR
Last Name:LUTHRA
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 1:1710 WUESTHOFF DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940
Mailing Address - Country:US
Mailing Address - Phone:321-255-6033
Mailing Address - Fax:321-255-6042
Practice Address - Street 1:1710 WUESTHOFF DR
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940
Practice Address - Country:US
Practice Address - Phone:321-255-6033
Practice Address - Fax:321-255-6042
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80626207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL58908OtherBCBS
FL262848100Medicaid
FLE4616YMedicare ID - Type Unspecified
H25638Medicare UPIN