Provider Demographics
NPI:1649560129
Name:CHIRUMAMILLA, RADHA (MD)
Entity Type:Individual
Prefix:
First Name:RADHA
Middle Name:
Last Name:CHIRUMAMILLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 PARNASSUS AVE
Mailing Address - Street 2:# U-404
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-2208
Mailing Address - Country:US
Mailing Address - Phone:415-476-1812
Mailing Address - Fax:
Practice Address - Street 1:25 NORTH WINFIELD ROAD
Practice Address - Street 2:STE. 400
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-1135
Practice Address - Country:US
Practice Address - Phone:630-456-7178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036135527207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine