MEDICARE: YASHWANTH YERRAMALLA 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	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	2016039972	MO
2	207RP1001X	Pulmonary Disease Physician	2016039972	MO
3	207RP1001X	Pulmonary Disease Physician	E-18477	AR

General Provider Information

NPI Number	:	1811331192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YASHWANTH YERRAMALLA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 776084
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-6084
Country	:	US
Telephone Number	:	314-543-6979
Fax Number	:	314-364-6321

Provider Business Practice Location Address
First Line	:	4600 MERCY LN STE 220
Second Line	:
City	:	SPRINGDALE
State	:	AR
Zip	:	72762-3070
Country	:	US
Telephone Number	:	479-347-3810
Fax Number	:	479-338-3089

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

Provider Enumeration Date	:	04/17/2013
Last Update Date	:	01/14/2025

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