Provider Demographics
NPI:1023364767
Name:PANCHANGAM, SRINIVAS KRISHNA CHAITANYA (MD)
Entity Type:Individual
Prefix:
First Name:SRINIVAS KRISHNA
Middle Name:CHAITANYA
Last Name:PANCHANGAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CHAITANYA
Other - Middle Name:
Other - Last Name:PANCHANGAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 843966
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3966
Mailing Address - Country:US
Mailing Address - Phone:573-884-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:500 N KEENE ST STE 207
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8104
Practice Address - Country:US
Practice Address - Phone:573-219-3960
Practice Address - Fax:573-219-3964
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-31
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301101250208000000X
MO20150216372080P0202X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology