MEDICARE: PRAJWAL CHEVIREDDY M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	E5630	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255543278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRAJWAL CHEVIREDDY M.D

Provider Business Mailing Address
First Line	:	9601 BAPTIST HEALTH DR
Second Line	:	STE 400
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-6399
Country	:	US
Telephone Number	:	501-224-2141
Fax Number	:	501-224-0506

Provider Business Practice Location Address
First Line	:	9601 BAPTIST HEALTH DR STE 350
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-6356
Country	:	US
Telephone Number	:	501-224-2141
Fax Number	:	501-224-0506

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	04/16/2018

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