Provider Demographics
NPI:1770642159
Name:KAVURI, CHOUDARY V (MD)
Entity Type:Individual
Prefix:DR
First Name:CHOUDARY
Middle Name:V
Last Name:KAVURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1770 E LAKESHORE DR
Mailing Address - Street 2:#208 CHOUDARY V KAVURI MD SC
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62521
Mailing Address - Country:US
Mailing Address - Phone:217-428-1900
Mailing Address - Fax:217-428-0358
Practice Address - Street 1:1770 E LAKESHORE DR
Practice Address - Street 2:#208 CHOUDARY V KAVURI MD SC
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62521
Practice Address - Country:US
Practice Address - Phone:217-428-1900
Practice Address - Fax:217-428-0358
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360720002084P0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05821917OtherBCBS
IL036072000Medicaid
260043363OtherRR MED
260043363OtherRR MED
IL036072000Medicaid