Provider Demographics
NPI:1689902983
Name:CHAKKA, CHANDANA THATIKONDA (MD)
Entity Type:Individual
Prefix:DR
First Name:CHANDANA
Middle Name:THATIKONDA
Last Name:CHAKKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CHANDANA
Other - Middle Name:
Other - Last Name:THATIKONDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:254-724-8800
Mailing Address - Fax:
Practice Address - Street 1:302 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-1032
Practice Address - Country:US
Practice Address - Phone:512-509-0200
Practice Address - Fax:512-218-6330
Is Sole Proprietor?:No
Enumeration Date:2009-11-24
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0679207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine