Provider Demographics
NPI:1245593979
Name:CHENNAMSETTY, SAI SUDHAKAR (MD)
Entity Type:Individual
Prefix:DR
First Name:SAI
Middle Name:SUDHAKAR
Last Name:CHENNAMSETTY
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 1:401 YOUNGSVILLE HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-5173
Mailing Address - Country:US
Mailing Address - Phone:337-330-0031
Mailing Address - Fax:337-330-0059
Practice Address - Street 1:401 YOUNGSVILLE HWY
Practice Address - Street 2:SUITE 200B
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-5173
Practice Address - Country:US
Practice Address - Phone:337-330-0031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA207907207R00000X
LAMD.207907207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2301942Medicaid