Provider Demographics
NPI:1922180595
Name:BILLAKANTI, GNANESWER (MD)
Entity Type:Individual
Prefix:
First Name:GNANESWER
Middle Name:
Last Name:BILLAKANTI
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 1:7627 GOSSAMER WIND ST
Mailing Address - Street 2:#330
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-5306
Mailing Address - Country:US
Mailing Address - Phone:702-964-1018
Mailing Address - Fax:702-487-7113
Practice Address - Street 1:620 SHADOW LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4119
Practice Address - Country:US
Practice Address - Phone:702-921-6823
Practice Address - Fax:702-549-5240
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10043207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1922180295Medicaid
NVG83519Medicare UPIN