Provider Demographics
NPI:1144429101
Name:DIABETES & ENDOCRINE CONSULTANTS PLLC
Entity Type:Organization
Organization Name:DIABETES & ENDOCRINE CONSULTANTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAMANA
Authorized Official - Middle Name:VENKATA
Authorized Official - Last Name:CHENNUBHOTLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-384-3401
Mailing Address - Street 1:9720 PARK PLAZA AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-2288
Mailing Address - Country:US
Mailing Address - Phone:502-384-3401
Mailing Address - Fax:502-384-3407
Practice Address - Street 1:9720 PARK PLAZA AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2288
Practice Address - Country:US
Practice Address - Phone:502-384-3401
Practice Address - Fax:502-384-3407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39338207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00390Medicare PIN