Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 2015021637 | MO |
N | 208000000X | Pediatrician | 4301101250 | MI |
N | 2080P0202X | Pediatric Cardiologist | 2015021637 | MO |
NPI | 1023364767 |
---|---|
Provider Name | Srinivas Krishna Chaitanya Panchangam |
First Address | Kansas City, MO 64184-3966 |
Second Address | Columbia, MO 65201-8104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2012 |
Last Update Date | 14/12/2018 |