Provider Demographics
NPI:1821290651
Name:YALAMANCHILI, KANTHI (MD)
Entity Type:Individual
Prefix:DR
First Name:KANTHI
Middle Name:
Last Name:YALAMANCHILI
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:PO BOX 35629
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-0629
Mailing Address - Country:US
Mailing Address - Phone:214-424-2200
Mailing Address - Fax:214-231-2159
Practice Address - Street 1:4370 MEDICAL ARTS DR STE 295
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1742
Practice Address - Country:US
Practice Address - Phone:972-691-3777
Practice Address - Fax:972-691-3666
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9562207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CW400OtherBLUE CROSS BLUE SHIELD
TX200340202Medicaid
TX200340202Medicaid
TX8CW400OtherBCBS PROVIDER ID
TXL9562OtherMEDICAL LICENSE
TXTXB132988Medicare PIN