Provider Demographics
NPI:1225531460
Name:KALAMA, RACHEAL DAMA
Entity Type:Individual
Prefix:
First Name:RACHEAL
Middle Name:DAMA
Last Name:KALAMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9203 W BLUEMOUND RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4484
Mailing Address - Country:US
Mailing Address - Phone:414-885-2678
Mailing Address - Fax:414-885-0462
Practice Address - Street 1:9203 W BLUEMOUND RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4484
Practice Address - Country:US
Practice Address - Phone:414-885-2678
Practice Address - Fax:414-885-0462
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-14
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100071401Medicaid