Provider Demographics
NPI:1902863038
Name:KADAMBI, ASHOK (MD)
Entity Type:Individual
Prefix:
First Name:ASHOK
Middle Name:
Last Name:KADAMBI
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 1:5010 W JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-6804
Mailing Address - Country:US
Mailing Address - Phone:260-436-1248
Mailing Address - Fax:260-436-7968
Practice Address - Street 1:5010 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-6804
Practice Address - Country:US
Practice Address - Phone:260-436-1248
Practice Address - Fax:260-436-7968
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01044753174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200088830AMedicaid
INF26122Medicare UPIN
IN200088830AMedicaid