Provider Demographics
NPI:1154439156
Name:BHAMIDIMARRI, KALYAN RAM (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:KALYAN
Middle Name:RAM
Last Name:BHAMIDIMARRI
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 NW 12TH AVENUE
Mailing Address - Street 2:PO BOX 016960 (M851)
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33101-6960
Mailing Address - Country:US
Mailing Address - Phone:305-243-7688
Mailing Address - Fax:
Practice Address - Street 1:2950 CLEVELAND CLINIC BLVD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3625
Practice Address - Country:US
Practice Address - Phone:954-659-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME110085207RG0100X, 207RT0003X
FLME 110085207RI0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
No207RT0003XAllopathic & Osteopathic PhysiciansInternal MedicineTransplant Hepatology