Provider Demographics
NPI:1841621752
Name:MODUKURU, VENKAT RAMANA (MBBS MD MRCS)
Entity type:Individual
Prefix:DR
First Name:VENKAT
Middle Name:RAMANA
Last Name:MODUKURU
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Gender:M
Credentials:MBBS MD MRCS
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Mailing Address - Street 1:29000 LITTLE MACK AVE
Mailing Address - Street 2:HAWASLI & ASSOCIATES SURGICAL SPECIALISTS ,P.C
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-3018
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:29000 LITTLE MACK AVE
Practice Address - Street 2:HAWASLI & ASSOCIATES SURGICAL SPECIALISTS ,P.C
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-3018
Practice Address - Country:US
Practice Address - Phone:586-774-8811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-02
Last Update Date:2016-09-01
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Provider Licenses
StateLicense IDTaxonomies
MI4301109465208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery