Provider Demographics
NPI:1881009538
Name:CHUNCHULU, SRIVANI (MD)
Entity Type:Individual
Prefix:
First Name:SRIVANI
Middle Name:
Last Name:CHUNCHULU
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 1:1600 E EVERGREEN ST
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:MO
Mailing Address - Zip Code:64429-2400
Mailing Address - Country:US
Mailing Address - Phone:816-632-2101
Mailing Address - Fax:816-649-3383
Practice Address - Street 1:1007 S POLK ST
Practice Address - Street 2:
Practice Address - City:MAYSVILLE
Practice Address - State:MO
Practice Address - Zip Code:64469-4030
Practice Address - Country:US
Practice Address - Phone:816-449-2123
Practice Address - Fax:816-449-2125
Is Sole Proprietor?:No
Enumeration Date:2014-06-20
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017022845207R00000X
OH35.144406208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine