Provider Demographics
NPI:1053599860
Name:RAMACHANDRA KOLACHALAM, MD PC
Entity type:Organization
Organization Name:RAMACHANDRA KOLACHALAM, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAMACHANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLACHALAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-751-6034
Mailing Address - Street 1:26850 PROVIDENCE PKWY
Mailing Address - Street 2:#460
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-1209
Mailing Address - Country:US
Mailing Address - Phone:586-751-6034
Mailing Address - Fax:
Practice Address - Street 1:26850 PROVIDENCE PKWY
Practice Address - Street 2:#460
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1209
Practice Address - Country:US
Practice Address - Phone:586-751-6034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRB060299208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF99832Medicare UPIN