Provider Demographics
NPI:1043334527
Name:MADALA, SOUMYA CHOWDARY (MD)
Entity type:Individual
Prefix:DR
First Name:SOUMYA
Middle Name:CHOWDARY
Last Name:MADALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SOUMYA
Other - Middle Name:
Other - Last Name:TALASILA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:245 STATE ST SE
Mailing Address - Street 2:STE 228
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4328
Mailing Address - Country:US
Mailing Address - Phone:616-685-1808
Mailing Address - Fax:
Practice Address - Street 1:260 JEFFERSON AVE SE
Practice Address - Street 2:STE 300
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4597
Practice Address - Country:US
Practice Address - Phone:616-685-6330
Practice Address - Fax:616-685-3010
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301085495207R00000X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine