Provider Demographics
NPI:1376510826
Name:BRAHMANANDAM, MADDIKUNTA (MD)
Entity Type:Individual
Prefix:
First Name:MADDIKUNTA
Middle Name:
Last Name:BRAHMANANDAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:M
Other - Middle Name:
Other - Last Name:BRAHMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2322 E 22ND ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-3176
Mailing Address - Country:US
Mailing Address - Phone:216-621-5000
Mailing Address - Fax:216-621-5034
Practice Address - Street 1:2322 E 22ND ST
Practice Address - Street 2:SUITE 302
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-3176
Practice Address - Country:US
Practice Address - Phone:216-621-5000
Practice Address - Fax:216-621-5034
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35040928207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0340287Medicaid
E88489Medicare UPIN
BR0439285Medicare ID - Type Unspecified