Provider Demographics
NPI:1053415695
Name:BHEEMANATHINI, VENUGOPALA S (MD)
Entity type:Individual
Prefix:
First Name:VENUGOPALA
Middle Name:S
Last Name:BHEEMANATHINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:522 E 11TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-4770
Mailing Address - Country:US
Mailing Address - Phone:256-237-5302
Mailing Address - Fax:256-237-5368
Practice Address - Street 1:522 E 11TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-4770
Practice Address - Country:US
Practice Address - Phone:256-237-5302
Practice Address - Fax:256-237-5368
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL21587207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009974770Medicaid
AL009974770Medicaid
AL051505840Medicare ID - Type UnspecifiedMEDICARE NUMBER