Healthcare Provider Details

I. General information

NPI: 1093923526
Provider Name (Legal Business Name): KRANTHI VEERAMACHANENI M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 06/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5580 W FLAMINGO RD
LAS VEGAS NV
89103-0111
US

IV. Provider business mailing address

PO BOX 15645
LAS VEGAS NV
89114-5645
US

V. Phone/Fax

Practice location:
  • Phone: 702-876-4449
  • Fax:
Mailing address:
  • Phone: 702-560-2886
  • Fax: 702-560-2928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number13510
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: