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Individual

DR. PRASANNA LAKSHMI YELAMANCHILI

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D

Contact information

Practice address
4007 GATEWAY BLVD, STE 100, NEWBURGH, IN 47630-8947
(812) 842-0907
(812) 490-7054
Mailing address
4015 GATEWAY BLVD STE 2120, NEWBURGH, IN 47630-8925
(812) 842-0907
(812) 464-4485

Taxonomy

Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
01067820A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000653732
ANTHEM
IN
05
200988120
IN
01
351776713
TRICARE PRIME
05
7100124460
KY
01
P00849717
RR MEDICARE
KY
01
P00849721
RR MEDICARE
IN
Enumeration date
04/12/2007
Last updated
10/28/2014
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