Provider Demographics
NPI:1972808483
Name:AMARA, VENKAT PRADEEPKUMAR (MD)
Entity type:Individual
Prefix:
First Name:VENKAT
Middle Name:PRADEEPKUMAR
Last Name:AMARA
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 1:3854 SHERIDAN ST STE A
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3630
Mailing Address - Country:US
Mailing Address - Phone:954-966-3018
Mailing Address - Fax:954-966-5249
Practice Address - Street 1:3854 SHERIDAN ST STE A
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3630
Practice Address - Country:US
Practice Address - Phone:954-966-3018
Practice Address - Fax:954-966-5249
Is Sole Proprietor?:No
Enumeration Date:2011-01-13
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME118739207RN0300X, 207RN0300X
390200000X
OH35.097754390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012855300Medicaid