Individual
RAMANA VENKATA CHENNUBHOTLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2410 RING RD STE 500, ELIZABETHTOWN, KY 42701-7991
(502) 559-3636
(502) 769-0931
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01051972A
IN
207R00000X
Internal Medicine Physician
39338
KY
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
01051972A
IN
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
39338
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64019722
—
KY
01
—
P00396051
RR MEDICARE
KY
Enumeration date
05/25/2006
Last updated
08/27/2021
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