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General NPI Number Information
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NPI Number | 1215033527
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Entity Type | Individual
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Provider Name | CHANDRALEKHA BOMMAKANTI M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 02/06/2013
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Provider Practice Location Address
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Address Line | 500 S OAKWOOD RD
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City | OSHKOSH
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State | WI
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Zip | 54904-7944
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Country | US
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Telephone | 920-223-3400
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Fax | 920-223-3404
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Provider Business Mailing Address
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Address Line | 500 S OAKWOOD RD
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City | OSHKOSH
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State | WI
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Zip | 54904-7944
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Country | US
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Telephone | 920-223-3400
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Fax | 920-223-3404
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 31641
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License Number State | WI
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