Healthcare Provider Details

I. General information

NPI: 1528179165
Provider Name (Legal Business Name): KALESWARA RAO ALLAMNENI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 WHITESPORT DR SW SUITE 102
HUNTSVILLE AL
35801-6452
US

IV. Provider business mailing address

400 WHITESPORT DR SW SUITE 102
HUNTSVILLE AL
35801-6452
US

V. Phone/Fax

Practice location:
  • Phone: 256-880-1200
  • Fax: 256-880-7272
Mailing address:
  • Phone: 256-880-1200
  • Fax: 256-880-7272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number00013815
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: