MEDICARE: VISHNU P YELAMANCHI MD

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	207RI0011X	Interventional Cardiology Physician	ME81426	FL
2	207RC0000X	Cardiovascular Disease Physician	ME81426	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	P00119597	OTHER	FL	MEDICARE RR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10724279	OTHER	FL	CAQH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	51757	OTHER	FL	BCBS
4	3820541	OTHER	FL	CIGNA
5	ME81426	OTHER	FL	STATE LICENSE NUMBER
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992788467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VISHNU P YELAMANCHI MD

Provider Business Mailing Address
First Line	:	PO BOX 2198
Second Line	:
City	:	LADY LAKE
State	:	FL
Zip	:	32158-2198
Country	:	US
Telephone Number	:	352-633-1966
Fax Number	:	352-633-1969

Provider Business Practice Location Address
First Line	:	1050 OLD CAMP RD
Second Line	:	STE 270
City	:	THE VILLAGES
State	:	FL
Zip	:	32162-1762
Country	:	US
Telephone Number	:	352-633-1966
Fax Number	:	352-633-1969

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

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	07/29/2012

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Directions to “ VISHNU P YELAMANCHI MD” Practice Location

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