Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | P5523 | TX |
NPI | 1023258043 |
---|---|
Provider Name | Dr. Anupama Chennupati |
First Address | Southlake, TX 76092-1536 |
Second Address | Burleson, TX 76028-7030 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2009 |
Last Update Date | 23/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1024338920001 | (05) | PA |
1024338920002 | (05) | PA |
2142845 | HIGHMARK BCBS (01) | PA |
3749707000 | INDEPENDENCE BLUE CROSS (01) | PA |