MEDICARE: L CHIRUMAMILLA MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	1046148	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801116025
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	L CHIRUMAMILLA MD PC

Provider Business Mailing Address
First Line	:	505 W HOMER ST
Second Line	:	SUITE 201
City	:	SALEM
State	:	IN
Zip	:	47167-1698
Country	:	US
Telephone Number	:	812-883-0090
Fax Number	:	812-883-0199

Provider Business Practice Location Address
First Line	:	505 W HOMER ST
Second Line	:	SUITE 201
City	:	SALEM
State	:	IN
Zip	:	47167-1698
Country	:	US
Telephone Number	:	812-883-0090
Fax Number	:	812-883-0199

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LATCHAIAH CHIRUMAMILLA
Credential	:	MD
Telephone Number	:	812-883-0090

Provider Enumeration Date	:	06/10/2010
Last Update Date	:	07/10/2010

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