Provider Demographics
NPI:1407812746
Name:MINNAGANTI, VENKAT R (MD)
Entity Type:Individual
Prefix:DR
First Name:VENKAT
Middle Name:R
Last Name:MINNAGANTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2300 N EDWARD ST
Mailing Address - Street 2:GSBLL
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-4163
Mailing Address - Country:US
Mailing Address - Phone:217-876-2857
Mailing Address - Fax:217-876-2874
Practice Address - Street 1:304 W HAY ST
Practice Address - Street 2:STE 212
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-6328
Practice Address - Country:US
Practice Address - Phone:217-876-4390
Practice Address - Fax:217-876-4395
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036105301207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK05134Medicare ID - Type Unspecified
ILH38400Medicare UPIN