MEDICARE: DR. VENKATA SAMBA SIVA RAO CHILAKAPATI MD

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	207RI0011X	Interventional Cardiology Physician	0101253145	VA
2	207RC0000X	Cardiovascular Disease Physician	Q4377	TX
3	207RC0000X	Cardiovascular Disease Physician	0101253145	VA
4	207RI0011X	Interventional Cardiology Physician	Q4377	TX
5	207R00000X	Internal Medicine Physician	Q4377	TX

General Provider Information

NPI Number	:	1679740310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VENKATA SAMBA SIVA RAO CHILAKAPATI MD

Provider Business Mailing Address
First Line	:	3400 COIT RD # 262609
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75075-3771
Country	:	US
Telephone Number	:	469-782-9860
Fax Number	:	469-461-3581

Provider Business Practice Location Address
First Line	:	4100 W 15TH ST STE 110
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-5826
Country	:	US
Telephone Number	:	469-782-9860
Fax Number	:	469-461-3581

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

Provider Enumeration Date	:	05/12/2008
Last Update Date	:	05/02/2023

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