Provider Demographics
NPI:1043252331
Name:VENNAM, RAMAKRISHNA (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMAKRISHNA
Middle Name:
Last Name:VENNAM
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 1:540 HUGHES RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-8999
Mailing Address - Country:US
Mailing Address - Phone:256-772-0573
Mailing Address - Fax:256-464-9578
Practice Address - Street 1:540 HUGHES RD
Practice Address - Street 2:SUITE 2
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-8999
Practice Address - Country:US
Practice Address - Phone:256-772-0573
Practice Address - Fax:256-464-9578
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12946207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000017718Medicaid
AL51017718OtherBCBS OF ALABAMA
ALC74260Medicare UPIN
000017718Medicare ID - Type Unspecified