Provider Demographics
NPI:1609991207
Name:VUNNAMADALA, KALYAN CHAKRAVARTHY (MD)
Entity type:Individual
Prefix:
First Name:KALYAN
Middle Name:CHAKRAVARTHY
Last Name:VUNNAMADALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:920 E 1ST ST STE 303
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-2225
Mailing Address - Country:US
Mailing Address - Phone:218-249-6050
Mailing Address - Fax:218-249-6055
Practice Address - Street 1:1923 S UTICA AVE FL 5
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-6520
Practice Address - Country:US
Practice Address - Phone:918-712-3366
Practice Address - Fax:918-403-6343
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK44780208G00000X
IAMD-42919208G00000X
AZ73347208G00000X
SD12011208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)