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General NPI Number Information
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NPI Number | 1083838130
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Entity Type | Individual
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Provider Name | PRASANNA LAKSHMI YELAMANCHILI M.D
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Gender | Female
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 10/28/2014
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Provider Practice Location Address
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Address Line | 4007 GATEWAY BLVD STE 100
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City | NEWBURGH
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State | IN
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Zip | 47630-8947
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Country | US
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Telephone | 812-842-0907
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Fax | 812-490-7054
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Provider Business Mailing Address
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Address Line | 4015 GATEWAY BLVD STE 2120
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City | NEWBURGH
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State | IN
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Zip | 47630-8925
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Country | US
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Telephone | 812-842-0907
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Fax | 812-464-4485
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 01067820A
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License Number State | IN
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