Provider Demographics
NPI:1356577076
Name:CHERUKURI, RAJA (MD)
Entity type:Individual
Prefix:
First Name:RAJA
Middle Name:
Last Name:CHERUKURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18731 MILLHOLLOW
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4256
Mailing Address - Country:US
Mailing Address - Phone:210-383-1518
Mailing Address - Fax:830-796-7744
Practice Address - Street 1:18731 MILLHOLLOW
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4256
Practice Address - Country:US
Practice Address - Phone:210-383-1518
Practice Address - Fax:830-931-3508
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3556208M00000X, 207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX205376115Medicaid
TXPENDINGMedicaid