MEDICARE: VENKATA S YELAMANCHILI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0011X	Interventional Cardiology Physician	01052115A	IN
2	207RC0000X	Cardiovascular Disease Physician	01052115A	IN
3	207RC0000X	Cardiovascular Disease Physician	34429	KY
4	207RI0011X	Interventional Cardiology Physician	34429	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	A11915	OTHER	HEALTHLINK
2	2092442	OTHER	UNITED HEALTHCARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	000000653335	OTHER	ANTHEM

General Provider Information

NPI Number	:	1225022866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VENKATA S YELAMANCHILI M.D.

Provider Business Mailing Address
First Line	:	4015 GATEWAY BLVD STE 2120
Second Line	:
City	:	NEWBURGH
State	:	IN
Zip	:	47630-8925
Country	:	US
Telephone Number	:	812-842-0907
Fax Number	:	812-464-4485

Provider Business Practice Location Address
First Line	:	4007 GATEWAY BLVD
Second Line	:	STE 100
City	:	NEWBURGH
State	:	IN
Zip	:	47630-8947
Country	:	US
Telephone Number	:	812-842-0907
Fax Number	:	812-490-7054

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	04/10/2015

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Directions to “ VENKATA S YELAMANCHILI M.D.” Practice Location

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