Provider Demographics
NPI:1912224031
Name:INDUKURI, CHAITANYA (MD)
Entity Type:Individual
Prefix:DR
First Name:CHAITANYA
Middle Name:
Last Name:INDUKURI
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 1:13625 RONALD REAGAN BLVD, BLDG 9
Mailing Address - Street 2:STE 100
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-2073
Mailing Address - Country:US
Mailing Address - Phone:512-856-5645
Mailing Address - Fax:512-729-6441
Practice Address - Street 1:13625 RONALD REAGAN BLVD
Practice Address - Street 2:BLDG 9, STE 100
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613
Practice Address - Country:US
Practice Address - Phone:512-856-5645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP9880207W00000X, 207WX0107X
WV27081207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology