Individual
JAGAN M. CHINTAMANENI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2311 N PROSPECT AVE, MILWAUKEE, WI 53211-4445
(414) 319-3000
Mailing address
4425 N PORT WASHINGTON RD, ATTN: CSMCP CLINIC CREDENTIALING, GLENDALE, WI 53212-1082
(414) 319-3000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
20904
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30138900
—
WI
Enumeration date
11/03/2006
Last updated
06/12/2012
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