Provider Demographics
NPI:1750585113
Name:CHITUMALLA, VENKAT VIKRAM (MD)
Entity type:Individual
Prefix:DR
First Name:VENKAT
Middle Name:VIKRAM
Last Name:CHITUMALLA
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 1:2980 S.E. 3RD COURT
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-0421
Mailing Address - Country:US
Mailing Address - Phone:352-622-4231
Mailing Address - Fax:352-622-0513
Practice Address - Street 1:2980 S.E. 3RD COURT
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0421
Practice Address - Country:US
Practice Address - Phone:352-622-4231
Practice Address - Fax:352-622-4231
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME109160207RN0300X
MI4301085558207R00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003847100Medicaid
F1009ZMedicare PIN