Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 57381 | MN |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 57381 | MN |
NPI | 1134412901 |
---|---|
Provider Name | Chandra Mouli Cherukuri |
First Address | Minneapolis, MN 55408-4708 |
Second Address | Minneapolis, MN 55408-4708 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2011 |
Last Update Date | 12/03/2020 |