Provider Demographics
NPI:1700184231
Name:CHITTIMIREDDY, SASIKALA (MD)
Entity Type:Individual
Prefix:
First Name:SASIKALA
Middle Name:
Last Name:CHITTIMIREDDY
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 1:14903 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77062-2603
Mailing Address - Country:US
Mailing Address - Phone:713-363-7640
Mailing Address - Fax:
Practice Address - Street 1:14903 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77062-2603
Practice Address - Country:US
Practice Address - Phone:713-363-7640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.121059207R00000X
TXP4556207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX347141901Medicaid
TX347141903Medicaid
OH0088055Medicaid
TX8EY781OtherBLUE CROSS BLUE SHIELD
TX8FT407OtherBLUE CROSS BLUE SHIELD
TX8FT407OtherBLUE CROSS BLUE SHIELD
TX347141903Medicaid
TX347141901Medicaid