Healthcare Provider Details

I. General information

NPI: 1952308959
Provider Name (Legal Business Name): ANIL KUMAR CHAGARLAMUDI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 10/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 DUNN ST
HOUMA LA
70360-4413
US

IV. Provider business mailing address

PO BOX 4176
HOUMA LA
70361-4176
US

V. Phone/Fax

Practice location:
  • Phone: 985-876-0300
  • Fax: 985-872-0317
Mailing address:
  • Phone: 985-876-0300
  • Fax: 985-872-0317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number15183R
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number15183R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: