Provider Demographics
NPI:1710143565
Name:THUMMALAKUNTA, ABHISHEK LAXMI NARASIMHA (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:ABHISHEK
Middle Name:LAXMI NARASIMHA
Last Name:THUMMALAKUNTA
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Gender:M
Credentials:MD, MPH
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Other - First Name:
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Mailing Address - Street 1:500 S UNIVERSITY AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5314
Mailing Address - Country:US
Mailing Address - Phone:501-664-3914
Mailing Address - Fax:501-664-5246
Practice Address - Street 1:500 S UNIVERSITY AVE STE 101
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5314
Practice Address - Country:US
Practice Address - Phone:501-664-3914
Practice Address - Fax:501-664-5246
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2023-11-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD440325207R00000X
ARE-113392085R0202X, 2085R0204X
IL036131256207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036131256Medicaid
ILIL3374062Medicare PIN