Provider Demographics
NPI:1376560268
Name:CHILLARA, BHAVANI (MD)
Entity Type:Individual
Prefix:
First Name:BHAVANI
Middle Name:
Last Name:CHILLARA
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 461309
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-5309
Mailing Address - Country:US
Mailing Address - Phone:303-239-0309
Mailing Address - Fax:303-239-0560
Practice Address - Street 1:455 S. HUDSON ST.
Practice Address - Street 2:LEVEL 2
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-1479
Practice Address - Country:US
Practice Address - Phone:303-388-4631
Practice Address - Fax:303-320-6961
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO44652207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07680066Medicaid
CO07680066Medicaid
CO811699Medicare PIN