Healthcare Provider Details

I. General information

NPI: 1497746499
Provider Name (Legal Business Name): ANU PRASAD VELLANKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 09/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

827 N PINE ST
GRAMERCY LA
70052-3659
US

IV. Provider business mailing address

PO BOX 419
GRAMERCY LA
70052-0419
US

V. Phone/Fax

Practice location:
  • Phone: 225-869-9200
  • Fax: 225-869-9241
Mailing address:
  • Phone: 225-869-9200
  • Fax: 225-869-9241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number12855R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: