Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251C2600X | Cardiopulmonary | 5501005886 | MI |
NPI | 1053400903 |
---|---|
Provider Name | Mrs. Shanthi V Venkat |
First Address | Perrysburg, OH 43551-5711 |
Second Address | Toledo, OH 41614 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 08/07/2007 |