Healthcare Provider Details

I. General information

NPI: 1477087872
Provider Name (Legal Business Name): AARON KUNAMALLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2017
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 PILGRIM RD # BAKER4
BOSTON MA
02215-5324
US

IV. Provider business mailing address

1717 W CONGRESS PKWY STE 307
CHICAGO IL
60612-3809
US

V. Phone/Fax

Practice location:
  • Phone: 617-667-8800
  • Fax:
Mailing address:
  • Phone: 312-942-6334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number125076866
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: