MEDICARE: JANNAIAH C. TRIPURANENI MD LLC

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	207R00000X	Internal Medicine Physician	R11566	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548299662
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JANNAIAH C. TRIPURANENI MD LLC

Provider Business Mailing Address
First Line	:	3136 S SAINT LANDRY AVE
Second Line	:
City	:	GONZALES
State	:	LA
Zip	:	70737-5801
Country	:	US
Telephone Number	:	225-715-6144
Fax Number	:	225-644-7769

Provider Business Practice Location Address
First Line	:	3136 S SAINT LANDRY AVE
Second Line	:
City	:	GONZALES
State	:	LA
Zip	:	70737-5801
Country	:	US
Telephone Number	:	225-715-6144
Fax Number	:	225-644-7769

Authorized Official
Title or Position	:	OWNER
Name	:	JANNAIAH C TRIPURANENI
Credential	:	MD
Telephone Number	:	225-715-6144

Provider Enumeration Date	:	07/01/2006
Last Update Date	:	08/08/2025

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