Provider Demographics
NPI:1922372812
Name:CHANDRASEKHAR POLEPALLE MD INC
Entity Type:Organization
Organization Name:CHANDRASEKHAR POLEPALLE MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-683-5939
Mailing Address - Street 1:3720 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-2141
Mailing Address - Country:US
Mailing Address - Phone:918-683-5939
Mailing Address - Fax:918-686-5590
Practice Address - Street 1:3720 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-2141
Practice Address - Country:US
Practice Address - Phone:918-683-5939
Practice Address - Fax:918-686-5590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-24
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
176625676POtherMEDICARE PTAN