Provider Demographics
NPI:1992849533
Name:CHILUKURI MDS LLC
Entity Type:Organization
Organization Name:CHILUKURI MDS LLC
Other - Org Name:NEWBURGH FAMILY PHYSICIANS, L.L.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISHNA
Authorized Official - Middle Name:R
Authorized Official - Last Name:CHILUKURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-858-5050
Mailing Address - Street 1:4166 WYNTREE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-2521
Mailing Address - Country:US
Mailing Address - Phone:812-858-5050
Mailing Address - Fax:812-858-3680
Practice Address - Street 1:4166 WYNTREE DR
Practice Address - Street 2:SUITE A
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-2521
Practice Address - Country:US
Practice Address - Phone:812-858-5050
Practice Address - Fax:812-858-3680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
139690Medicare PIN