Provider Demographics
NPI:1326298779
Name:TADAKAMALLA, ASHVIN KARTHIK (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHVIN
Middle Name:KARTHIK
Last Name:TADAKAMALLA
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 1:900 MARTIN LUTHER KING JR BLVD S
Mailing Address - Street 2:#G129 FOX POINTE APARTMENTS
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-2900
Mailing Address - Country:US
Mailing Address - Phone:630-945-1247
Mailing Address - Fax:
Practice Address - Street 1:44405 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5023
Practice Address - Country:US
Practice Address - Phone:248-858-3234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY284882208M00000X
MIL1346413208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No208600000XAllopathic & Osteopathic PhysiciansSurgery