Provider Demographics
NPI:1184865552
Name:VEERABHADRA CHIRRAVURI PLLC
Entity type:Organization
Organization Name:VEERABHADRA CHIRRAVURI PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:VEERABHADRA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIRRAVURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-887-0700
Mailing Address - Street 1:PO BOX 1086
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42241-1086
Mailing Address - Country:US
Mailing Address - Phone:270-887-0700
Mailing Address - Fax:270-885-3776
Practice Address - Street 1:315 COOL WATER CT
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-8738
Practice Address - Country:US
Practice Address - Phone:270-887-0700
Practice Address - Fax:270-885-3776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-16
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35171207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00958OtherMEDICARE PTAN