Organization
PEDIATRIC PULMONARY & CRITICAL CARE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHANDRASHEKHAR CHOWDARY YALAMANCHALI M.D. (OWNER/PRESIDENT)
(260) 435-7800
Entity
Organization
Contact information
Practice address
7910 WEST JEFFERSON BLVD., STE 205, FORT WAYNE, IN 46804-4159
(260) 435-7800
(260) 435-7007
Mailing address
PMB 218 10214 CHESTNUT PLAZA DRIVE, FORT WAYNE, IN 46814-8970
(260) 435-7800
(260) 435-7007
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
—
—
2080P0203X
Pediatric Critical Care Medicine Physician
01049779A
IN
2080P0203X
Pediatric Critical Care Medicine Physician
—
—
2080P0214X
Pediatric Pulmonology Physician
Primary
01049779A
IN
2080P0214X
Pediatric Pulmonology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200231310
—
IN
05
—
200246880
—
IN
05
—
200500220
—
IN
Enumeration date
03/09/2007
Last updated
03/06/2012
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