Provider Demographics
NPI:1932168143
Name:CHITTAJALLU, RAVI SHANKAR (MD)
Entity Type:Individual
Prefix:DR
First Name:RAVI
Middle Name:SHANKAR
Last Name:CHITTAJALLU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7610 N STEMMONS FWY STE 600
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4228
Mailing Address - Country:US
Mailing Address - Phone:214-689-5960
Mailing Address - Fax:469-713-8084
Practice Address - Street 1:4521 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 500
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-1651
Practice Address - Country:US
Practice Address - Phone:972-562-8383
Practice Address - Fax:972-548-8388
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2844207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G9580OtherBCBSTX
TX154584001Medicaid
TX8A1539Medicare PIN
TXG49207Medicare UPIN
TX154584001Medicaid