Provider Demographics
NPI:1972637866
Name:VEMURI, VENU (DO)
Entity Type:Individual
Prefix:
First Name:VENU
Middle Name:
Last Name:VEMURI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6420 DUTCHMANS PKWY STE 250
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-3372
Mailing Address - Country:US
Mailing Address - Phone:502-242-6370
Mailing Address - Fax:502-242-6540
Practice Address - Street 1:6420 DUTCHMANS PKWY STE 250
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-3372
Practice Address - Country:US
Practice Address - Phone:502-242-6370
Practice Address - Fax:502-242-6540
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY03034207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200869170AMedicaid
KY000000529332OtherANTHEM / SPINE INSTITUTE
KY000000530348OtherANTHEM / UNIV ORTHO ASSOC
KY7100027110Medicaid
KY0605946Medicare PIN
KY0235850Medicare PIN
ININ1920001Medicare PIN
IN200869170AMedicaid