Provider Demographics
NPI:1134274095
Name:VEERAMACHANENI, JYOTHI (MD)
Entity type:Individual
Prefix:
First Name:JYOTHI
Middle Name:
Last Name:VEERAMACHANENI
Suffix:
Gender:F
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:PO BOX 80257
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208-8004
Mailing Address - Country:US
Mailing Address - Phone:414-935-8000
Mailing Address - Fax:414-287-0907
Practice Address - Street 1:1218 W KILBOURN AVE STE 124
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-1325
Practice Address - Country:US
Practice Address - Phone:414-935-8000
Practice Address - Fax:414-220-5184
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1798-850207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35332400Medicaid
WI35332400Medicaid
WI35332400Medicaid
WI01994-0344Medicare PIN