Provider Demographics
NPI:1245214501
Name:CHILUKURI, KAUSALYA (MD)
Entity Type:Individual
Prefix:
First Name:KAUSALYA
Middle Name:
Last Name:CHILUKURI
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 1:4166 WYNTREE DR
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-2521
Mailing Address - Country:US
Mailing Address - Phone:812-858-5050
Mailing Address - Fax:812-858-3680
Practice Address - Street 1:4166 WYNTREE DR
Practice Address - Street 2:SUITE A
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-2521
Practice Address - Country:US
Practice Address - Phone:812-858-5050
Practice Address - Fax:812-858-3680
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039517A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F33871Medicare UPIN
139690AMedicare ID - Type Unspecified