Individual
VENKATA K THOTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4448 W. LOOMIS RD., STE 100, GREENFIELD, WI 53220-4851
(414) 281-5150
(414) 281-5767
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
28604
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31484200
—
WI
Enumeration date
04/12/2006
Last updated
07/11/2024
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