Provider Demographics
NPI:1346203775
Name:YERRAMILLI, VENKATA R (MD)
Entity Type:Individual
Prefix:
First Name:VENKATA
Middle Name:R
Last Name:YERRAMILLI
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 1:3302 BONITA BEACH RD
Mailing Address - Street 2:#170
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-4216
Mailing Address - Country:US
Mailing Address - Phone:239-624-1050
Mailing Address - Fax:239-624-1051
Practice Address - Street 1:3302 BONITA BEACH RD STE 170
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-4217
Practice Address - Country:US
Practice Address - Phone:239-624-1050
Practice Address - Fax:239-624-1051
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME109954207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14CR6OtherBCBS
FLEZ010XOtherBCBS
FL003569500Medicaid
FL14CR6OtherBCBS
F89015Medicare UPIN