Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 125050331 | IL |
N | 111NI0900X | Internist | 125050331 | IL |
Y | 207RI0011X | Interventional Cardiology | 70364 | WI |
NPI | 1003009358 |
---|---|
Provider Name | Vamsi Kiran Kodumuri |
First Address | Mount Pleasant, WI 53405-1660 |
Second Address | Mount Pleasant, WI 53405-1660 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2007 |
Last Update Date | 25/01/2019 |