Individual
DR. RADHA CHINTAMANENI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
97 S 4TH ST, ISHPEMING, MI 49849-2168
(906) 485-5583
(906) 485-5676
Mailing address
2837 US HIGHWAY 41 W, MARQUETTE, MI 49855-2252
(906) 225-3964
(906) 226-3875
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
4301046858
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0520034
BLUE CROSS BLUE SHIELD MI
MI
05
—
1519630
—
MI
Enumeration date
10/29/2007
Last updated
10/29/2007
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