Provider Demographics
NPI:1497918528
Name:CHUNDURI, SIRISHA (MD)
Entity Type:Individual
Prefix:
First Name:SIRISHA
Middle Name:
Last Name:CHUNDURI
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 1437
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36536-1437
Mailing Address - Country:US
Mailing Address - Phone:214-696-8033
Mailing Address - Fax:214-361-2552
Practice Address - Street 1:6901 SNIDER PLZ
Practice Address - Street 2:STE#130
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-5648
Practice Address - Country:US
Practice Address - Phone:214-696-8033
Practice Address - Fax:214-361-2552
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.098074208M00000X
TXQ0895207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810021793Medicaid
OH000000737151OtherANTHEM
OHP01015059OtherMEDICARE RAILROAD
OH0055361Medicaid
OH0055361Medicaid