Kalluru Vijayabhanu, MD

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

License

37250 Issued in WI

Practice address

5228 W Fond Du Lac Ave
Milwaukee, WI 53216

Phone

(414) 536-2100

Fax

(414) 536-2311

NPI assigned

Oct 16, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Manikonda Vijayarhanu Former name

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1144310475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8520 N GREENVALE RD",
            "city": "BAYSIDE",
            "state": "WI",
            "postal_code": "53217",
            "telephone_number": "414-228-9446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5228 W FOND DU LAC AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "53216",
            "telephone_number": "414-536-2100",
            "fax_number": "414-536-2311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIJAYABHANU",
        "first_name": "KALLURU",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "WI",
            "license": "37250",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MANIKONDA",
            "last_name": "VIJAYARHANU",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ajjampur Ramachandrarao Vidyaranya, M.D.
• Alexandria Grace Vieth, SAC-IT
• Karly Vigani
• Donald Joseph Viglia
• Sydney Avalon Vignali
• Rajakrishnan Vijayakrishnan, MD
• Anita Vijayakumar, MD
• Aravind Vijayapal, MD
• Nicole Vike, LPC, ATR-BC
• Heather Vilbrandt

• Geriatric Medicine (Internal Medicine) Physician in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Geriatric Medicine (Internal Medicine) Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.