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General NPI Number Information
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NPI Number | 1144429101
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Entity Type | Organization
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Legal Business Name | DIABETES & ENDOCRINE CONSULTANTS PLLC
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Dates
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Enumeration Date | 07/11/2007
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Last Update Date | 04/25/2011
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Provider Practice Location Address
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Address Line | 9720 PARK PLAZA AVE SUITE 101
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City | LOUISVILLE
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State | KY
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Zip | 40241-2288
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Country | US
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Telephone | 502-384-3401
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Fax | 502-384-3407
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Provider Business Mailing Address
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Address Line | 9720 PARK PLAZA AVE SUITE 101
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City | LOUISVILLE
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State | KY
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Zip | 40241-2288
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Country | US
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Telephone | 502-384-3401
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Fax | 502-384-3407
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Authorized Official
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Title or Position | OWNER
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Name | RAMANA VENKATA CHENNUBHOTLA
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Credential | M.D.
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Telephone | 502-384-3401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 39338
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 39338
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License Number State | KY
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