Healthcare Provider Details

I. General information

NPI: 1346245024
Provider Name (Legal Business Name): SARAT CHANDRA PACHALLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 10/29/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19550 E 39TH ST S SUITE 220
INDEPENDENCE MO
64057-2358
US

IV. Provider business mailing address

19550 E 39TH ST S SUITE 215
INDEPENDENCE MO
64057-2358
US

V. Phone/Fax

Practice location:
  • Phone: 816-461-6837
  • Fax: 816-833-1760
Mailing address:
  • Phone: 816-461-6837
  • Fax: 816-833-1760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number2000158765
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number2000158765
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: