MEDICARE: KALPANA AJJAMPORE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	38369	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518903665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KALPANA AJJAMPORE MD

Provider Business Mailing Address
First Line	:	4425 N PORT WASHINGTON RD
Second Line	:	ATTN: CSMCP CLINIC CREDENTIALING
City	:	GLENDALE
State	:	WI
Zip	:	53212-1082
Country	:	US
Telephone Number	:	414-773-6300
Fax Number	:

Provider Business Practice Location Address
First Line	:	2727 N MAYFAIR RD
Second Line	:	SUITE I
City	:	WAUWATOSA
State	:	WI
Zip	:	53222-4400
Country	:	US
Telephone Number	:	414-773-6300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	05/24/2011

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