Individual
DR. SUMANTH MULAMALLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
15900 W 101ST AVE, DYER, IN 46311-3065
(219) 365-6333
(219) 365-8291
Mailing address
210 S DESPLAINES ST, CHICAGO, IL 60661-5500
(312) 654-2700
(312) 654-9930
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
01065980A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201121060A
—
IN
01
—
F400289465
IL MEDICARE PTAN
IL
Enumeration date
06/11/2007
Last updated
04/21/2016
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