Provider Demographics
NPI:1376511139
Name:UPPUTURI, CHANDRASEKHAR P (MD)
Entity Type:Individual
Prefix:DR
First Name:CHANDRASEKHAR
Middle Name:P
Last Name:UPPUTURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 VALLEY VIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6138
Mailing Address - Country:US
Mailing Address - Phone:309-762-5560
Mailing Address - Fax:309-762-7351
Practice Address - Street 1:545 VALLEY VIEW DRIVE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6138
Practice Address - Country:US
Practice Address - Phone:309-762-5560
Practice Address - Fax:309-762-7351
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-108464207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036108464Medicaid
H99944Medicare UPIN
ILK03433Medicare PIN