Provider Demographics
NPI:1215243175
Name:BOPPANA, VENKATA SUBBARAO CHOWDARY (MD)
Entity type:Individual
Prefix:
First Name:VENKATA SUBBARAO
Middle Name:CHOWDARY
Last Name:BOPPANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 N WEBB RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-8127
Mailing Address - Country:US
Mailing Address - Phone:316-686-5300
Mailing Address - Fax:316-651-2660
Practice Address - Street 1:3535 N WEBB RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-8127
Practice Address - Country:US
Practice Address - Phone:316-686-5300
Practice Address - Fax:316-651-2660
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-28
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-39962207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201161990AMedicaid
KSKA3651023OtherMEDICARE