Provider Demographics
NPI:1992788467
Name:YELAMANCHI, VISHNU P (MD)
Entity type:Individual
Prefix:
First Name:VISHNU
Middle Name:P
Last Name:YELAMANCHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2198
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32158-2198
Mailing Address - Country:US
Mailing Address - Phone:352-633-1966
Mailing Address - Fax:352-633-1969
Practice Address - Street 1:1050 OLD CAMP RD
Practice Address - Street 2:STE 270
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-1762
Practice Address - Country:US
Practice Address - Phone:352-633-1966
Practice Address - Fax:352-633-1969
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2012-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME81426207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10724279OtherCAQH
FL260284900Medicaid
FL51757OtherBCBS
FL3820541OtherCIGNA
FLME81426OtherSTATE LICENSE NUMBER
FLP00119597OtherMEDICARE RR
FLP00119597OtherMEDICARE RR
FLG19342Medicare UPIN