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General NPI Number Information
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NPI Number | 1629382148
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Entity Type | Individual
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Provider Name | VENKATA BHARADWAJ KOLLI MBBS
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Gender | Male
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Dates
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Enumeration Date | 07/27/2010
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Last Update Date | 05/15/2015
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Provider Practice Location Address
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Address Line | 985582 NEBRASKA MEDICAL CTR DEPARTMENT OF PSYCHIATRY
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City | OMAHA
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State | NE
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Zip | 68198-5582
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Country | US
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Telephone | 402-717-5550
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Fax |
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Provider Business Mailing Address
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Address Line | 9222 BURT ST APT:118
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City | OMAHA
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State | NE
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Zip | 68114-2479
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Country | US
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Telephone | 402-717-5550
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Fax |
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 6389
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License Number State | NE
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