Provider Demographics
NPI:1487835229
Name:CHILAKALA, SANDEEP K (MD)
Entity Type:Individual
Prefix:
First Name:SANDEEP
Middle Name:K
Last Name:CHILAKALA
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 1:853 JEFFERSON AVENUE, SUITE 201
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103
Mailing Address - Country:US
Mailing Address - Phone:901-448-4750
Mailing Address - Fax:901-302-2993
Practice Address - Street 1:853 JEFFERSON AVENUE, SUITE 201
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103
Practice Address - Country:US
Practice Address - Phone:901-448-4750
Practice Address - Fax:901-302-2993
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN498782080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1487835229Medicaid
TN1532717Medicaid
MS00422575Medicaid
AL179200Medicaid
AR196437001Medicaid
GA003180578AMedicaid