Provider Demographics
NPI:1992325724
Name:CHANAMOLU, DIMPLE KUMAR
Entity type:Individual
Prefix:
First Name:DIMPLE KUMAR
Middle Name:
Last Name:CHANAMOLU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41-17-30 KRISHNA LANKA DINTYAVARI STREET
Mailing Address - Street 2:OPP RAVINDRA BHARATHI SCHOOL
Mailing Address - City:VIJAYAWADA
Mailing Address - State:ANDHRA PRADESH
Mailing Address - Zip Code:520013
Mailing Address - Country:IN
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:DEPTARMENT OF UROLOGY UNIVERSITY OF MIAMA MILLER SCHOOL
Practice Address - Street 2:CRB 1120 NW 14TH STREET SUITE 1551C
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136
Practice Address - Country:US
Practice Address - Phone:305-243-3670
Practice Address - Fax:305-243-4653
Is Sole Proprietor?:No
Enumeration Date:2020-04-22
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WV31956208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program