Provider Demographics
NPI:1245505254
Name:CHIKKALA, SUBHA (MD)
Entity type:Individual
Prefix:
First Name:SUBHA
Middle Name:
Last Name:CHIKKALA
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 1:3550 LAKELINE BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-3504
Mailing Address - Country:US
Mailing Address - Phone:512-986-7372
Mailing Address - Fax:512-986-7392
Practice Address - Street 1:3550 LAKELINE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-3504
Practice Address - Country:US
Practice Address - Phone:512-986-7372
Practice Address - Fax:512-986-7392
Is Sole Proprietor?:No
Enumeration Date:2012-03-09
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP5163207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine