MEDICARE: ABHISHEK CHALLA

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	204F00000X	Transplant Surgery Physician	7322	NE
2	207RG0100X	Gastroenterology Physician	94-09778	KS

General Provider Information

NPI Number	:	1477968659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABHISHEK CHALLA

Provider Business Mailing Address
First Line	:	PO BOX 206239
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75320-6239
Country	:	US
Telephone Number	:	210-614-1234
Fax Number	:

Provider Business Practice Location Address
First Line	:	11212 STATE HIGHWAY 151 MEDICAL PLAZA, 1
Second Line	:	SUITE 250
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-4507
Country	:	US
Telephone Number	:	210-614-1234
Fax Number	:

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

Provider Enumeration Date	:	06/25/2014
Last Update Date	:	06/03/2022

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Directions to “ ABHISHEK CHALLA ” Practice Location

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