Provider Demographics
NPI:1922080084
Name:CHENNUPATI, BALA M (MD)
Entity Type:Individual
Prefix:DR
First Name:BALA
Middle Name:M
Last Name:CHENNUPATI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:250 CHATEAU DR SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-3497
Mailing Address - Country:US
Mailing Address - Phone:256-881-1989
Mailing Address - Fax:256-319-1907
Practice Address - Street 1:250 CHATEAU DR SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-3497
Practice Address - Country:US
Practice Address - Phone:256-881-1989
Practice Address - Fax:256-319-1907
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL20454207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALG43386Medicare UPIN