Provider Demographics
NPI:1790787158
Name:CHEKURU, SYAMALA (MD)
Entity Type:Individual
Prefix:
First Name:SYAMALA
Middle Name:
Last Name:CHEKURU
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 1:3420 22ND PL
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1314
Mailing Address - Country:US
Mailing Address - Phone:806-725-5844
Mailing Address - Fax:806-723-6532
Practice Address - Street 1:3506 21ST ST
Practice Address - Street 2:SUITE 602
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1212
Practice Address - Country:US
Practice Address - Phone:806-725-4730
Practice Address - Fax:806-723-6735
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMDF5171207RP1001X
TXF5171208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX089546803Medicaid
TX8CV646OtherBCBS
NM000W8189Medicaid
TX110211104OtherFIRSTCARE
TX8CV646OtherBCBS
TX110211104OtherFIRSTCARE