Provider Demographics
NPI:1386687010
Name:KOLACHALAM, RAMACHANDRA B (MD)
Entity Type:Individual
Prefix:
First Name:RAMACHANDRA
Middle Name:B
Last Name:KOLACHALAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:R
Other - Middle Name:B
Other - Last Name:KOLACHALAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:26850 PROVIDENCE PARKWAY
Mailing Address - Street 2:#460
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-1265
Mailing Address - Country:US
Mailing Address - Phone:248-662-4272
Mailing Address - Fax:
Practice Address - Street 1:26850 PROVIDENCE PARKWAY
Practice Address - Street 2:#460
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1265
Practice Address - Country:US
Practice Address - Phone:248-662-4272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRK060299208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M27250Medicare UPIN