Healthcare Provider Details

I. General information

NPI: 1386083533
Provider Name (Legal Business Name): CHITRALEKHA PASUPULETI M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2013
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3630 W 4TH ST
WATERLOO IA
50701-4504
US

IV. Provider business mailing address

3630 W 4TH ST
WATERLOO IA
50701-4504
US

V. Phone/Fax

Practice location:
  • Phone: 319-235-7246
  • Fax:
Mailing address:
  • Phone: 319-235-7246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number506027
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD60653818
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD57750
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: