Provider Demographics
NPI:1154325421
Name:VENKATACHALAM, KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:KUMAR
Middle Name:
Last Name:VENKATACHALAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8558 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7032
Mailing Address - Country:US
Mailing Address - Phone:219-392-7084
Mailing Address - Fax:219-703-6854
Practice Address - Street 1:8895 BROADWAY
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-7037
Practice Address - Country:US
Practice Address - Phone:219-738-2081
Practice Address - Fax:219-736-4658
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01048257A207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN110168975OtherRAILROAD MEDICARE
IL9115389OtherANTHEM BC/BS
IN200180870AMedicaid
IN000000085025OtherANTHEM BC/BS
IN496850IMedicare PIN
G58617Medicare UPIN