Provider Demographics
NPI:1013063817
Name:SUNIL REDDY CHERUKU, MD, PA
Entity type:Organization
Organization Name:SUNIL REDDY CHERUKU, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNIL
Authorized Official - Middle Name:REDDY
Authorized Official - Last Name:CHERUKU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-750-1535
Mailing Address - Street 1:1918 LEANDER RD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-8835
Mailing Address - Country:US
Mailing Address - Phone:737-808-4561
Mailing Address - Fax:877-260-0030
Practice Address - Street 1:900 E 30TH ST STE 109
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-3323
Practice Address - Country:US
Practice Address - Phone:512-544-5555
Practice Address - Fax:512-544-4143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X, 207PE0005X
TXK4023207RS0012X, 208M00000X, 2083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1466203Medicaid
TX00311RMedicare PIN
TXG56853Medicare UPIN