Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | E4358 | AR |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | E4358 | AR |
NPI | 1104862200 |
---|---|
Provider Name | Dr. Mangaraju Chakka |
First Address | Little Rock, AR 72205-6202 |
Second Address | Little Rock, AR 72205-6202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2006 |
Last Update Date | 04/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
157168001 | (05) | AR |
919591 | MALP INS # (01) | AR |
I28708 | (02) | AR |