Provider Demographics
NPI:1952434797
Name:CONSULTANTS MEDICAL GROUP
Entity Type:Organization
Organization Name:CONSULTANTS MEDICAL GROUP
Other - Org Name:CAPITAL HEMATOLOGY ONCOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:UMA
Authorized Official - Middle Name:H
Authorized Official - Last Name:GOWDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-782-5106
Mailing Address - Street 1:TWO MEDICAL PLAZA
Mailing Address - Street 2:STE 200
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661
Mailing Address - Country:US
Mailing Address - Phone:916-782-5106
Mailing Address - Fax:916-783-4361
Practice Address - Street 1:TWO MEDICAL PLAZA
Practice Address - Street 2:STE 200
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661
Practice Address - Country:US
Practice Address - Phone:916-782-5106
Practice Address - Fax:916-783-4361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA446140207RH0003X
CAG654860207RH0003X
CAG582580207RH0003X
CAA776420207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ15630ZOtherMEDICARE PTAN
CAZZZ15630ZOtherPTAN
CAA446140OtherUMA GOWDA, M D
CAA776420OtherSIVAKUMAR REDDY, M D
CAG582580OtherKRISTIE BOBOLIS, M D
CAG654860OtherDONALD COLBOURN, M D
CAZZZ15630ZOtherMEDICARE PTAN