Provider Demographics
NPI:1700049558
Name:VENEPALLI, PREETHI KIRAN (MD)
Entity Type:Individual
Prefix:
First Name:PREETHI
Middle Name:KIRAN
Last Name:VENEPALLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8558 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7032
Mailing Address - Country:US
Mailing Address - Phone:219-239-2170
Mailing Address - Fax:219-270-3168
Practice Address - Street 1:407 W INDIANA AVE
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-2350
Practice Address - Country:US
Practice Address - Phone:219-763-8112
Practice Address - Fax:219-764-5384
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.128154208000000X
CAA119131208000000X
IN01072539A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201174280Medicaid