Provider Demographics
NPI:1598299265
Name:CHELAMKURI PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:CHELAMKURI PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:SATYA
Authorized Official - Middle Name:V
Authorized Official - Last Name:CHELAMKURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-208-7373
Mailing Address - Street 1:19155 CAMINO BARCO
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-5617
Mailing Address - Country:US
Mailing Address - Phone:585-208-7373
Mailing Address - Fax:248-494-7440
Practice Address - Street 1:19155 CAMINO BARCO
Practice Address - Street 2:
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-5617
Practice Address - Country:US
Practice Address - Phone:585-208-7373
Practice Address - Fax:248-494-7440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-19
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA111532207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1063672244Medicaid