MEDICARE: DR. SAI SUDHAKAR CHENNAMSETTY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	207907	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245593979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAI SUDHAKAR CHENNAMSETTY M.D.

Provider Business Mailing Address
First Line	:	401 YOUNGSVILLE HWY
Second Line	:	SUITE 100
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-5173
Country	:	US
Telephone Number	:	337-330-0031
Fax Number	:	337-330-0059

Provider Business Practice Location Address
First Line	:	401 YOUNGSVILLE HWY
Second Line	:	SUITE 200B
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-5173
Country	:	US
Telephone Number	:	337-330-0031
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2012
Last Update Date	:	09/14/2016

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