Provider Demographics
NPI:1023286945
Name:KANTHIMATHINATHAN, VENKATASUBRAMANIAN (MD)
Entity type:Individual
Prefix:DR
First Name:VENKATASUBRAMANIAN
Middle Name:
Last Name:KANTHIMATHINATHAN
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 1:6043 WINTHROP COMMERCE AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-4274
Mailing Address - Country:US
Mailing Address - Phone:813-291-0629
Mailing Address - Fax:
Practice Address - Street 1:6043 WINTHROP COMMERCE AVE STE 201
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-4274
Practice Address - Country:US
Practice Address - Phone:813-291-0629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD446487208600000X
ALMD.42785208600000X
CAA102298208600000X
FLME163458208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL272926Medicaid