Healthcare Provider Details

I. General information

NPI: 1730317272
Provider Name (Legal Business Name): VENKATA ERELLA MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 06/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11851 JOLLYVILLE RD SUITE 104
AUSTIN TX
78759-2338
US

IV. Provider business mailing address

11851 JOLLEYVILLE ROAD SUITE 104
AUSTIN TX
78759-2350
US

V. Phone/Fax

Practice location:
  • Phone: 512-257-2425
  • Fax: 512-257-2426
Mailing address:
  • Phone: 512-257-2425
  • Fax: 512-257-2426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. VENKATA S ERELLA
Title or Position: OWNER
Credential: MD
Phone: 812-391-3949