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General NPI Number Information
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NPI Number | 1770874992
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Entity Type | Individual
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Provider Name | DEEPTHI YELAVARTHI D.O.
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Gender | Female
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Dates
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Enumeration Date | 04/21/2011
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Last Update Date | 07/31/2017
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Provider Practice Location Address
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Address Line | 2901 W KINNICKINNIC RIVER PKWY SUITE 315
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City | MILWAUKEE
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State | WI
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Zip | 53215-3677
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Country | US
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Telephone | 414-325-7246
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Fax |
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Provider Business Mailing Address
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Address Line | 141 N JEFFERSON ST APT 209
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City | MILWAUKEE
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State | WI
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Zip | 53202-6142
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Country | US
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Telephone | 219-309-4467
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 62421
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License Number State | WI
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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 | OS016243
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 62421
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | H79477
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License Number State | MD
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