Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 0101267891 | VA |
N | 207RC0200X | Critical Care Medicine | 246774 | NY |
Y | 207RC0200X | Critical Care Medicine | ME108555 | FL |
NPI | 1003041815 |
---|---|
Provider Name | Dr. Sreedhar Chintala |
First Address | Lake Worth, FL 33467 |
Second Address | Palm Beach Gardens, FL 33410 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2009 |
Last Update Date | 24/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003122800 | (05) | FL |
ME108555 | FL LICENSE (01) | FL |