Provider Demographics
NPI:1992956122
Name:ALAMELUMANGAPURAM, CHIDAMBER BHARATH (MD)
Entity type:Individual
Prefix:
First Name:CHIDAMBER
Middle Name:BHARATH
Last Name:ALAMELUMANGAPURAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:201 NORTH EAST AVE
Mailing Address - Street 2:HOSPITALIST OFFICE
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201
Mailing Address - Country:US
Mailing Address - Phone:517-205-1328
Mailing Address - Fax:517-205-1330
Practice Address - Street 1:201 NORTH EAST AVE
Practice Address - Street 2:HOSPITALIST OFFICE
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201
Practice Address - Country:US
Practice Address - Phone:517-205-1328
Practice Address - Fax:517-205-1330
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01084354A208M00000X
MI4301100175207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist