MEDICARE: SREEKANTH CHANDRUPATLA 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	207RG0100X	Gastroenterology Physician	ME87546	FL

General Provider Information

NPI Number	:	1881623767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SREEKANTH CHANDRUPATLA M.D.

Provider Business Mailing Address
First Line	:	6410 W GULF TO LAKE HWY
Second Line	:
City	:	CRYSTAL RIVER
State	:	FL
Zip	:	34429-7622
Country	:	US
Telephone Number	:	352-563-2450
Fax Number	:	352-563-2512

Provider Business Practice Location Address
First Line	:	6410 W GULF TO LAKE HWY
Second Line	:
City	:	CRYSTAL RIVER
State	:	FL
Zip	:	34429-7622
Country	:	US
Telephone Number	:	352-563-2450
Fax Number	:	352-563-2512

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

Provider Enumeration Date	:	07/02/2006
Last Update Date	:	07/08/2007

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