Provider Demographics
NPI:1124383088
Name:GORANTLA, RAMAKRISHNA SAI (MBBS, MD)
Entity type:Individual
Prefix:
First Name:RAMAKRISHNA
Middle Name:SAI
Last Name:GORANTLA
Suffix:
Gender:M
Credentials:MBBS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42ND AND EMILE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-0001
Mailing Address - Country:US
Mailing Address - Phone:402-559-0995
Mailing Address - Fax:
Practice Address - Street 1:42ND AND EMILE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-1009
Practice Address - Country:US
Practice Address - Phone:402-559-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-06
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE36066207RI0011X
IN01086460A207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease