Healthcare Provider Details

I. General information

NPI: 1912918574
Provider Name (Legal Business Name): SRINIVAS C. CHEVURU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 GREATSTONE PT FL 2
LEXINGTON KY
40504-3274
US

IV. Provider business mailing address

236 W MAIN ST
MOUNT STERLING KY
40353-1348
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-6211
  • Fax: 859-257-7706
Mailing address:
  • Phone: 859-404-7686
  • Fax: 859-498-8160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number37888
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number37888
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: