Individual
VENKATESAN R GORANTLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
655 W 8TH ST FL CC6, JACKSONVILLE, FL 32209-6511
(513) 310-2392
Mailing address
655 W 8TH ST FL CC6, JACKSONVILLE, FL 32209-6511
(513) 310-2392
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
ME102628
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000593692
ANTHEM PROVIDER NUMBER
IN
05
—
200523260
—
IN
Enumeration date
07/05/2006
Last updated
08/28/2025
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