Provider Demographics
NPI:1609847029
Name:CHALLAPALLI, MADHU B (MD)
Entity Type:Individual
Prefix:
First Name:MADHU
Middle Name:B
Last Name:CHALLAPALLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4411 MEDICAL DR STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3824
Mailing Address - Country:US
Mailing Address - Phone:210-614-5400
Mailing Address - Fax:210-614-2413
Practice Address - Street 1:1139 E SONTERRA BLVD STE 520
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4347
Practice Address - Country:US
Practice Address - Phone:210-490-6000
Practice Address - Fax:210-490-4658
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL0999207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00898228OtherMEDICARE RAILROAD
TX165060803Medicaid
TX8CM501OtherBCBS
TXTXB112469OtherMEDICARE
TXTXB112469OtherMEDICARE
I05371Medicare UPIN
TX8CM501OtherBCBS
TX165060801Medicaid