Provider Demographics
NPI:1376700039
Name:VENKAT, SURYADUTT (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:SURYADUTT
Middle Name:
Last Name:VENKAT
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5575 FRISCO SQUARE BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-3309
Mailing Address - Country:US
Mailing Address - Phone:945-800-7803
Mailing Address - Fax:
Practice Address - Street 1:5575 FRISCO SQUARE BLVD STE 210
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-3309
Practice Address - Country:US
Practice Address - Phone:945-800-7803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU5251207QG0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine