MEDICARE: DR. CHAITANYA SWAROOP PUVVADA 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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1417744616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHAITANYA SWAROOP PUVVADA M.D.

Provider Business Mailing Address
First Line	:	2400 W. VILLARD AVENUE
Second Line	:	MS. SANDRA OLSEN
City	:	MILWAUKEE
State	:	WI
Zip	:	53209
Country	:	US
Telephone Number	:	414-527-8415
Fax Number	:

Provider Business Practice Location Address
First Line	:	2301 N LAKE DR
Second Line	:	COLUMBIA ST. MARY'S HOSPITAL
City	:	MILWAUKEE
State	:	WI
Zip	:	53211
Country	:	US
Telephone Number	:	414-737-6170
Fax Number	:

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

Provider Enumeration Date	:	04/22/2025
Last Update Date	:	12/22/2025

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