Provider Demographics
NPI:1730317272
Name:VENKATA ERELLA MD LLC
Entity Type:Organization
Organization Name:VENKATA ERELLA MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VENKATA
Authorized Official - Middle Name:S
Authorized Official - Last Name:ERELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-391-3949
Mailing Address - Street 1:11851 JOLLEYVILLE ROAD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-2350
Mailing Address - Country:US
Mailing Address - Phone:512-257-2425
Mailing Address - Fax:512-257-2426
Practice Address - Street 1:11851 JOLLYVILLE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-2338
Practice Address - Country:US
Practice Address - Phone:512-257-2425
Practice Address - Fax:512-257-2426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty