Provider Demographics
NPI:1215470638
Name:GNANESWER BILLAKANTI MD PC
Entity type:Organization
Organization Name:GNANESWER BILLAKANTI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GNANESWER
Authorized Official - Middle Name:
Authorized Official - Last Name:BILLAKANTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-964-1013
Mailing Address - Street 1:7627 GOSSAMER WIND ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-5306
Mailing Address - Country:US
Mailing Address - Phone:702-964-1013
Mailing Address - Fax:702-487-7113
Practice Address - Street 1:7627 GOSSAMER WIND ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89139-5306
Practice Address - Country:US
Practice Address - Phone:702-964-1013
Practice Address - Fax:702-487-7113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-03
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10043207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty