Provider Demographics
NPI:1215033527
Name:BOMMAKANTI, CHANDRALEKHA (MD)
Entity Type:Individual
Prefix:DR
First Name:CHANDRALEKHA
Middle Name:
Last Name:BOMMAKANTI
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 1:500 S OAKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54904-7944
Mailing Address - Country:US
Mailing Address - Phone:920-223-3400
Mailing Address - Fax:920-223-3404
Practice Address - Street 1:500 S OAKWOOD RD
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-7944
Practice Address - Country:US
Practice Address - Phone:920-223-3400
Practice Address - Fax:920-223-3404
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI316412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31765700Medicaid
WI31765700Medicaid
WI100815Medicare ID - Type Unspecified