Healthcare Provider Details

I. General information

NPI: 1205763786
Provider Name (Legal Business Name): CHANDANA TUMMALA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 N. LAKE DRIVE, ASCENSION COLUMBIA ST. MARY'S HOSPI
MILWAUKEE WI
53211
US

IV. Provider business mailing address

2301 N. LAKE DRIVE, ASCENSION COLUMBIA ST. MARY'S HOSPI
MILWAUKEE WI
53211
US

V. Phone/Fax

Practice location:
  • Phone: 414-585-1000
  • Fax: 414-585-1113
Mailing address:
  • Phone: 414-585-1000
  • Fax: 414-585-1113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: