Provider Demographics
NPI:1225022866
Name:YELAMANCHILI, VENKATA S (MD)
Entity Type:Individual
Prefix:
First Name:VENKATA
Middle Name:S
Last Name:YELAMANCHILI
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 1:4015 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:2005-09-09
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01052115A207RI0011X, 207RC0000X
KY34429207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
A11915OtherHEALTHLINK
2092442OtherUNITED HEALTHCARE
KY64034515Medicaid
000000653335OtherANTHEM
KYP400018141Medicare PIN
KY64034515Medicaid
INM400017997Medicare PIN