Provider Demographics
NPI:1033215967
Name:CHAMARTHY, USHASREE (MD)
Entity Type:Individual
Prefix:
First Name:USHASREE
Middle Name:
Last Name:CHAMARTHY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:USHASREE
Other - Middle Name:
Other - Last Name:CHODIMELLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3593 BEECH TREE LN
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-3869
Mailing Address - Country:US
Mailing Address - Phone:248-390-2116
Mailing Address - Fax:
Practice Address - Street 1:1030 W MICHIGAN ST FL 2
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5201
Practice Address - Country:US
Practice Address - Phone:317-944-0920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301077085207R00000X, 207RH0003X
IN01092487A207RH0003X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4663020Medicaid
MI1103311651OtherBCBS INDIVIDUAL PIN
MI4663020Medicaid
MIG89703Medicare UPIN