Organization
L CHIRUMAMILLA, MD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDI L LILLY (CREDENTIALING SPECIALIST)
(812) 989-5495
Entity
Organization
Contact information
Practice address
3058 WOLF LAKE BLVD, NEW ALBANY, IN 47150-9584
(812) 987-2294
Mailing address
PO BOX 511, SELLERSBURG, IN 47172-0511
(812) 987-2294
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01046148A
IN
Other
Enumeration date
05/11/2017
Last updated
05/11/2017
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