Provider Demographics
NPI:1003237934
Name:CHAKRALA, JAHNAVI (MD)
Entity Type:Individual
Prefix:
First Name:JAHNAVI
Middle Name:
Last Name:CHAKRALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20229 E 9 MILE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-1775
Mailing Address - Country:US
Mailing Address - Phone:586-267-0200
Mailing Address - Fax:313-343-4412
Practice Address - Street 1:20229 E 9 MILE RD STE 200
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1775
Practice Address - Country:US
Practice Address - Phone:586-267-0200
Practice Address - Fax:313-343-4412
Is Sole Proprietor?:No
Enumeration Date:2013-12-19
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301502783207RE0101X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism