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NPI Code Detail

MEDICARE: AJITHA YELURU

MEDICARE: AJITHA YELURU
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
1390200000XStudent in an Organized Health Care Education/Training Program
2208000000XPediatrics PhysicianE-14534AR

General Provider Information

NPI Number : 1487130696
Entity Type Code : Individual
Provider Name (Legal Business Name) : AJITHA YELURU
Provider Business Mailing Address
First Line : 5 MEDICAL PARK DR STE GL2
Second Line :
City : BENTON
State : AR
Zip : 72015-3745
Country : US
Telephone Number : 501-574-7337
Fax Number :
Provider Business Practice Location Address
First Line : 5 MEDICAL PARK DR STE GL2
Second Line :
City : BENTON
State : AR
Zip : 72015-3745
Country : US
Telephone Number : 501-574-7337
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2018
Last Update Date : 07/31/2021

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Directions to “ AJITHA YELURU ” Practice Location

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