Provider Demographics
NPI:1144222142
Name:VENKATAKRISHNA, KANAKAPURA (MD)
Entity Type:Individual
Prefix:DR
First Name:KANAKAPURA
Middle Name:
Last Name:VENKATAKRISHNA
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 1:120 W 22ND ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1563
Mailing Address - Country:US
Mailing Address - Phone:630-573-5000
Mailing Address - Fax:
Practice Address - Street 1:11104 PARKVIEW CIRCLE DR
Practice Address - Street 2:ENTRANCE 11, SUITE 330
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1730
Practice Address - Country:US
Practice Address - Phone:260-494-3484
Practice Address - Fax:260-969-0188
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.067919207RN0300X
IN01045053A207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200093260Medicaid
IN100082060Medicaid
IN000000095598OtherBCBS
OH0310587Medicaid
IN100082060Medicaid
IN200093260Medicaid
IN628850JMedicare PIN
IN628850Medicare PIN
IN000000095598OtherBCBS
INCA5480Medicare PIN