Provider Demographics
NPI:1174503304
Name:CHIVUKULA, KRISHNA KISHORE (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISHNA
Middle Name:KISHORE
Last Name:CHIVUKULA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3120 FREDERICK RD
Mailing Address - Street 2:SUITE I
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-7134
Mailing Address - Country:US
Mailing Address - Phone:334-887-0955
Mailing Address - Fax:334-887-0964
Practice Address - Street 1:3120 FREDERICK RD
Practice Address - Street 2:SUITE I
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-7134
Practice Address - Country:US
Practice Address - Phone:334-887-0955
Practice Address - Fax:334-887-0964
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL222782084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALH05358Medicare UPIN