Provider Demographics
NPI:1942465802
Name:CHEKKILLA, CHAITANYA (MD)
Entity Type:Individual
Prefix:DR
First Name:CHAITANYA
Middle Name:
Last Name:CHEKKILLA
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 1:6626 E. 75TH STREET
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8920 SOUTHPOINTE DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-7505
Practice Address - Country:US
Practice Address - Phone:317-497-1900
Practice Address - Fax:317-497-1919
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301092318390200000X
IN01069637A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01539670OtherMEDICARE RR
IN201030680Medicaid
IN266180472Medicare PIN