Provider Demographics
NPI:1710621933
Name:CHALISE, ADITI (MD)
Entity Type:Individual
Prefix:
First Name:ADITI
Middle Name:
Last Name:CHALISE
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 1:4900 MUELLER BLVD STE 3K.032
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-3051
Mailing Address - Country:US
Mailing Address - Phone:512-324-0067
Mailing Address - Fax:
Practice Address - Street 1:4900 MUELLER BLVD STE 3K.032
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-3051
Practice Address - Country:US
Practice Address - Phone:512-324-0067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10078862208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics