Provider Demographics
NPI:1083838130
Name:YELAMANCHILI, PRASANNA LAKSHMI (MD)
Entity Type:Individual
Prefix:DR
First Name:PRASANNA
Middle Name:LAKSHMI
Last Name:YELAMANCHILI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4015 GATEWAY BLVD STE 2120
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-8925
Mailing Address - Country:US
Mailing Address - Phone:812-842-0907
Mailing Address - Fax:812-464-4485
Practice Address - Street 1:4007 GATEWAY BLVD
Practice Address - Street 2:STE 100
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-8947
Practice Address - Country:US
Practice Address - Phone:812-842-0907
Practice Address - Fax:812-490-7054
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01067820A207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100124460Medicaid
351776713OtherTRICARE PRIME
IN200988120Medicaid
KYP00849717OtherRR MEDICARE
INP00849721OtherRR MEDICARE
IN000000653732OtherANTHEM
IN200988120Medicaid
KYP400018129Medicare PIN
IN200988120Medicaid
IL$$$$$$$$$ 1Medicaid