Provider Demographics
NPI:1962631341
Name:VELAMURI VENKATA, SAI RAMAKRISHNA (MD)
Entity Type:Individual
Prefix:
First Name:SAI RAMAKRISHNA
Middle Name:
Last Name:VELAMURI VENKATA
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 1:6571 OAK ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-6623
Mailing Address - Country:US
Mailing Address - Phone:310-562-9293
Mailing Address - Fax:
Practice Address - Street 1:WALLACE PLASTIC SURGERY
Practice Address - Street 2:1000 BROOKFIELD RD STE 100
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119
Practice Address - Country:US
Practice Address - Phone:901-779-6538
Practice Address - Fax:901-685-2717
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20150161322086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03922205Medicaid
TNQ024670Medicaid