Provider Demographics
NPI:1235137266
Name:CHILUKURI, SYAM S (MD)
Entity Type:Individual
Prefix:DR
First Name:SYAM
Middle Name:S
Last Name:CHILUKURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:950 S KENMORE DR STE B
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-7513
Mailing Address - Country:US
Mailing Address - Phone:812-301-8110
Mailing Address - Fax:812-401-4001
Practice Address - Street 1:950 S KENMORE DR STE B
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-7513
Practice Address - Country:US
Practice Address - Phone:812-301-8110
Practice Address - Fax:812-401-4001
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01041516A208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01041516AOtherSTATE LICENSE
IN200004020Medicaid
IN000000282879OtherANTHEM BC/BS
KY64296874Medicaid
KY64296874Medicaid
IN846900EMedicare PIN