Provider Demographics
NPI:1407951882
Name:CHILUKURI, MOHAN M (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAN
Middle Name:M
Last Name:CHILUKURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4705 UNIVERSITY DR BLDG 700
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-3489
Mailing Address - Country:US
Mailing Address - Phone:919-237-1337
Mailing Address - Fax:919-237-1625
Practice Address - Street 1:2400 BROAD ST
Practice Address - Street 2:SUITE 1
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2661
Practice Address - Country:US
Practice Address - Phone:919-220-9800
Practice Address - Fax:919-220-9500
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC9300061207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8922353Medicaid
NC2190000EMedicare ID - Type Unspecified
NC8922353Medicaid