Provider Demographics
NPI:1790740850
Name:CHINTAMANENI, KUMARI S (MD)
Entity Type:Individual
Prefix:
First Name:KUMARI
Middle Name:S
Last Name:CHINTAMANENI
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 1:3267 SO 16TH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-4500
Mailing Address - Country:US
Mailing Address - Phone:414-671-1449
Mailing Address - Fax:414-671-0161
Practice Address - Street 1:3267 SO 16TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-4500
Practice Address - Country:US
Practice Address - Phone:414-671-1449
Practice Address - Fax:414-671-0161
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI28498207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31560200Medicaid
WI31560200Medicaid
E74218Medicare UPIN