Healthcare Provider Details

I. General information

NPI: 1750722401
Provider Name (Legal Business Name): SITARAM CHILAKAMARRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2013
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2946 E BANNER GATEWAY DR
GILBERT AZ
85234
US

IV. Provider business mailing address

2946 E BANNER GATEWAY DR
GILBERT AZ
85234
US

V. Phone/Fax

Practice location:
  • Phone: 480-256-6444
  • Fax: 480-256-3682
Mailing address:
  • Phone: 480-256-6444
  • Fax: 480-256-3682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number78996
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberS7190
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberS7190
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: