Provider Demographics
NPI:1417330283
Name:CHINTALACHERUVU, LAKSHMI MANOGNA (MD)
Entity Type:Individual
Prefix:MRS
First Name:LAKSHMI MANOGNA
Middle Name:
Last Name:CHINTALACHERUVU
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 3988
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62902-3988
Mailing Address - Country:US
Mailing Address - Phone:618-457-5200
Mailing Address - Fax:
Practice Address - Street 1:1400 PIN OAK DR
Practice Address - Street 2:
Practice Address - City:CARTERVILLE
Practice Address - State:IL
Practice Address - Zip Code:62918-1600
Practice Address - Country:US
Practice Address - Phone:618-985-3333
Practice Address - Fax:618-985-1318
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036156370207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology