Provider Demographics
NPI:1093724460
Name:CHENNUPATI, NEELIMA (MD)
Entity Type:Individual
Prefix:DR
First Name:NEELIMA
Middle Name:
Last Name:CHENNUPATI
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:PO BOX 424
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50302-0424
Mailing Address - Country:US
Mailing Address - Phone:515-875-9925
Mailing Address - Fax:515-875-9923
Practice Address - Street 1:1360 NW 18TH ST STE 102
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-9105
Practice Address - Country:US
Practice Address - Phone:515-875-9730
Practice Address - Fax:515-875-9731
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA33515207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1209494Medicaid
IA1209494Medicaid
IA1209494Medicaid