Provider Demographics
NPI:1053620617
Name:KUSUMA-TALAKADU, MADAIAH (MD)
Entity type:Individual
Prefix:
First Name:MADAIAH
Middle Name:
Last Name:KUSUMA-TALAKADU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 N MACOMB ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-3085
Mailing Address - Country:US
Mailing Address - Phone:734-243-5720
Mailing Address - Fax:734-243-9261
Practice Address - Street 1:814 N MACOMB ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-3085
Practice Address - Country:US
Practice Address - Phone:734-243-5720
Practice Address - Fax:734-243-9261
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301096025208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics