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General NPI Number Information
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NPI Number | 1609991207
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Entity Type | Individual
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Provider Name | KALYAN CHAKRAVARTHY VUNNAMADALA M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 1923 S UTICA AVE FL 5
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City | TULSA
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State | OK
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Zip | 74104-6520
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Country | US
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Telephone | 918-712-3366
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Fax | 918-403-6343
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Provider Business Mailing Address
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Address Line | 920 E 1ST ST STE 303
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City | DULUTH
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State | MN
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Zip | 55805-2225
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Country | US
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Telephone | 218-249-6050
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Fax | 218-249-6055
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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 | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 44780
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | MD-42919
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 73347
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 12011
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License Number State | SD
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