Provider Demographics
NPI:1952692915
Name:YALAMANCHILI, VENKAT (MD)
Entity Type:Individual
Prefix:
First Name:VENKAT
Middle Name:
Last Name:YALAMANCHILI
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 1:1031 PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-4669
Mailing Address - Country:US
Mailing Address - Phone:419-557-5568
Mailing Address - Fax:419-557-6979
Practice Address - Street 1:703 TYLER ST STE 351
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-3391
Practice Address - Country:US
Practice Address - Phone:419-621-7620
Practice Address - Fax:419-621-7623
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-26
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.016242208600000X
OH351350592086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery