Provider Demographics
NPI:1851377527
Name:KANTAMNENI, VENKATA BABU (MD)
Entity Type:Individual
Prefix:
First Name:VENKATA
Middle Name:BABU
Last Name:KANTAMNENI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 HIGHWAY 31 SOUTH SUITE 117
Mailing Address - Street 2:PO BOX 3017
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35602
Mailing Address - Country:US
Mailing Address - Phone:256-351-2116
Mailing Address - Fax:256-351-2128
Practice Address - Street 1:2828 HIGHWAY 31 SOUTH
Practice Address - Street 2:SUITE 117
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35602
Practice Address - Country:US
Practice Address - Phone:256-351-2116
Practice Address - Fax:256-351-2128
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00014244207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000045596Medicaid
AL000045596Medicare ID - Type Unspecified
D83869Medicare UPIN