Provider Demographics
NPI:1588860811
Name:CHINIMILLI, MAHESWARI (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHESWARI
Middle Name:
Last Name:CHINIMILLI
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 1:6210 E HWY 290
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-1142
Mailing Address - Country:US
Mailing Address - Phone:512-483-9596
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:940 W UNIVERSITY AVE STE 101
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-5430
Practice Address - Country:US
Practice Address - Phone:512-819-0264
Practice Address - Fax:512-406-6242
Is Sole Proprietor?:No
Enumeration Date:2007-06-24
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT-188942207Q00000X
TXN3558207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX212218603Medicaid
TX449845YNBVMedicare PIN