Provider Demographics
NPI:1376741751
Name:CHERUKURI, MANJEERA (MD)
Entity type:Individual
Prefix:
First Name:MANJEERA
Middle Name:
Last Name:CHERUKURI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MANJEERA
Other - Middle Name:
Other - Last Name:GORLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:800 W RANDOL MILL RD STE 2300
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-2504
Mailing Address - Country:US
Mailing Address - Phone:817-960-6648
Mailing Address - Fax:817-960-6649
Practice Address - Street 1:800 W RANDOL MILL RD STE 2300
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2504
Practice Address - Country:US
Practice Address - Phone:817-960-6648
Practice Address - Fax:817-960-6649
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD432382207R00000X
TXN9440207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX273497YKPWMedicare PIN