Provider Demographics
NPI:1528179165
Name:ALLAMNENI, KALESWARA RAO (MD)
Entity Type:Individual
Prefix:DR
First Name:KALESWARA RAO
Middle Name:
Last Name:ALLAMNENI
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 1:400 WHITESPORT DR SW
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-6452
Mailing Address - Country:US
Mailing Address - Phone:256-880-1200
Mailing Address - Fax:256-880-7272
Practice Address - Street 1:400 WHITESPORT DR SW
Practice Address - Street 2:SUITE 102
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6452
Practice Address - Country:US
Practice Address - Phone:256-880-1200
Practice Address - Fax:256-880-7272
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00013815207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL80879OtherBLUECROSS PROVIDER NUMBER
AL19058OtherBLUE CROSS
AL19058Medicaid
AL80879OtherBLUECROSS PROVIDER NUMBER
AL19058Medicare ID - Type UnspecifiedHUNTSVILLE PROVIDER #
AL80879Medicare ID - Type UnspecifiedATHENS PROVIDER #