Provider Demographics
NPI:1760575278
Name:CHERUKU, KIRAN KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:KIRAN
Middle Name:KUMAR
Last Name:CHERUKU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1933NELOOP 410
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5320
Mailing Address - Country:US
Mailing Address - Phone:210-804-6000
Mailing Address - Fax:210-804-6069
Practice Address - Street 1:1933 NE LOOP 410
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5320
Practice Address - Country:US
Practice Address - Phone:210-804-6000
Practice Address - Fax:210-804-6069
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-108300207R00000X
TXM8595207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L10166Medicare UPIN