Provider Demographics
NPI:1629382148
Name:KOLLI, VENKATA BHARADWAJ (MBBS)
Entity Type:Individual
Prefix:DR
First Name:VENKATA
Middle Name:BHARADWAJ
Last Name:KOLLI
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:9222 BURT ST
Mailing Address - Street 2:APT:118
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2479
Mailing Address - Country:US
Mailing Address - Phone:402-717-5550
Mailing Address - Fax:
Practice Address - Street 1:985582 NEBRASKA MEDICAL CTR
Practice Address - Street 2:DEPARTMENT OF PSYCHIATRY
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-5582
Practice Address - Country:US
Practice Address - Phone:402-717-5550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE63892084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry