Provider Demographics
NPI:1477968659
Name:CHALLA, ABHISHEK
Entity Type:Individual
Prefix:
First Name:ABHISHEK
Middle Name:
Last Name:CHALLA
Suffix:
Gender:M
Credentials:
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 206239
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-6239
Mailing Address - Country:US
Mailing Address - Phone:210-614-1234
Mailing Address - Fax:
Practice Address - Street 1:11212 STATE HIGHWAY 151 MEDICAL PLAZA, 1
Practice Address - Street 2:SUITE 250
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4507
Practice Address - Country:US
Practice Address - Phone:210-614-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-25
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7322204F00000X
KS94-09778207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery