Provider Demographics
NPI:1295738128
Name:KAMO, ALKA (MD)
Entity type:Individual
Prefix:DR
First Name:ALKA
Middle Name:
Last Name:KAMO
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 1:965 RIDGE LAKE BLVD STE 315
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:901-227-8591
Practice Address - Street 1:6019 WALNUT GROVE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2113
Practice Address - Country:US
Practice Address - Phone:901-226-3610
Practice Address - Fax:901-226-3612
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2021-07-19
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
ARE-14324207R00000X
TN30512207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3826065Medicaid
TN3724417Medicare ID - Type UnspecifiedGROUP
TN3826065Medicaid
TNG77969Medicare UPIN
TN3826062Medicare ID - Type UnspecifiedINDIVIDUAL