Individual
DR. MALATHI TADAKAMALLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
600 NE MEADOWVIEW DR, LEES SUMMIT, MO 64064-1983
(913) 226-7332
(913) 674-5563
Mailing address
PO BOX 219209, KANSAS CITY, MO 64121-9209
(913) 226-7332
(913) 674-5563
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
2009003023
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA3153001,
MEDICARE PTAN
MO
Enumeration date
06/13/2006
Last updated
05/14/2015
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