Healthcare Provider Details

I. General information

NPI: 1801704754
Provider Name (Legal Business Name): ANIL KIRAN CHOKKALLA PHD, D(ABCC), NRCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

737 BROADWAY N
FARGO ND
58102-4421
US

IV. Provider business mailing address

2920 SHEYENNE ST APT 518
WEST FARGO ND
58078-6018
US

V. Phone/Fax

Practice location:
  • Phone: 701-234-2450
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QC1000X
TaxonomyChemistry Pathology Specialist/Technologist
License Number1351
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: