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General NPI Number Information
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NPI Number | 1699045641
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Entity Type | Individual
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Provider Name | VENKATA YEARVA M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/09/2012
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 800 CLAY ST
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City | DARLINGTON
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State | WI
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Zip | 53530-1228
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Country | US
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Telephone | 419-552-5915
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Fax |
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Provider Business Mailing Address
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Address Line | 208 E ANN ST APT B
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City | DARLINGTON
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State | WI
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Zip | 53530-1400
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Country | US
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Telephone | 419-552-5915
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 01076716A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 2240-320
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License Number State | WI
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