Provider Demographics
NPI:1437314143
Name:PARACHURI, VENU GOPAL (MD)
Entity type:Individual
Prefix:DR
First Name:VENU
Middle Name:GOPAL
Last Name:PARACHURI
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 1:1000 E 5TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-3307
Mailing Address - Country:US
Mailing Address - Phone:035-905-0009
Mailing Address - Fax:
Practice Address - Street 1:1000 E 5TH ST STE 100
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-3307
Practice Address - Country:US
Practice Address - Phone:035-905-0009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU97682084N0402X, 2084S0012X
ND126522084N0402X
WI55602-0202084N0402X
MI4301091742208000000X
ORMD1774182084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000169713Medicaid
NDN720182Medicare PIN