Basic Information
| Provider Information | |||||||||
| NPI: | 1336249200 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OBI | ||||||||
| FirstName: | VANAJA | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KAMISETTY-OBILISETTY | ||||||||
| OtherFirstName: | VANAJA | ||||||||
| OtherMiddleName: | R | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 501 S SANTA FE AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SALINA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 674014189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858252273 | ||||||||
| FaxNumber: | 7858252275 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 S SANTA FE AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SALINA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 674014189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858252273 | ||||||||
| FaxNumber: | 7858252275 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2006 | ||||||||
| LastUpdateDate: | 05/20/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 04-24593 | KS | Y | Allopathic & Osteopathic Physicians | Pediatrics | 207RE0101X | 04-24593 | KS | N | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | 2080P0205X | 04-24593 | KS | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Endocrinology |
ID Information
| ID | Type | State | Issuer | Description | 100147460BC | 05 | KS | MEDICAID |