Provider Demographics
NPI:1154065605
Name:NEKKANTI, ANKITA CHOWDARY (MBBS,)
Entity type:Individual
Prefix:MISS
First Name:ANKITA
Middle Name:CHOWDARY
Last Name:NEKKANTI
Suffix:
Gender:F
Credentials:MBBS,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 NE GLEN OAK AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61637-0001
Mailing Address - Country:US
Mailing Address - Phone:309-624-3598
Mailing Address - Fax:
Practice Address - Street 1:530 N.E. GLEN OAK AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61637
Practice Address - Country:US
Practice Address - Phone:309-655-6384
Practice Address - Fax:309-655-7732
Is Sole Proprietor?:No
Enumeration Date:2022-04-21
Last Update Date:2025-05-27
Deactivation Date:2023-01-18
Deactivation Code:
Reactivation Date:2024-02-27
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL036.173749207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program