Basic Information
| Provider Information | |||||||||
| NPI: | 1124078027 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TUMMALA | ||||||||
| FirstName: | RAMACHANDRA | ||||||||
| MiddleName: | PRASAD | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 420 DELAWARE STREET SE MMC 96 | ||||||||
| Address2: | DEPT OF NEUROSURGERY | ||||||||
| City: | MPLS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6126246666 | ||||||||
| FaxNumber: | 6126240644 | ||||||||
| Practice Location | |||||||||
| Address1: | 516 DELAWARE STREET SE CLINIC 1A | ||||||||
| Address2: | NEUROSURGERY AT UNIV OF MN | ||||||||
| City: | MPLS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6126246666 | ||||||||
| FaxNumber: | 6126240644 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2006 | ||||||||
| LastUpdateDate: | 10/29/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 237509 | NY | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | 42776 | MN | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.