Individual
DR. KODIHALLI P CHANNABASAPPA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
607 W DUE WEST AVE, SUITE 122, MADISON, TN 37115-4431
(615) 865-6111
Mailing address
607 W DUE WEST AVE, SUITE 122, MADISON, TN 37115-4431
(615) 865-6111
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
010618
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3163326
—
TN
Enumeration date
09/22/2006
Last updated
01/18/2008
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