Healthcare Provider Details

I. General information

NPI: 1245214501
Provider Name (Legal Business Name): KAUSALYA CHILUKURI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 06/13/2022
Certification Date: 06/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4166 WYNTREE DR SUITE A
NEWBURGH IN
47630-2521
US

IV. Provider business mailing address

4166 WYNTREE DR
NEWBURGH IN
47630-2521
US

V. Phone/Fax

Practice location:
  • Phone: 812-858-5050
  • Fax: 812-858-3680
Mailing address:
  • Phone: 812-858-5050
  • Fax: 812-858-3680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01039517A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: