Healthcare Provider Details

I. General information

NPI: 1275610032
Provider Name (Legal Business Name): SRIDHAR S CHILIMURI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 GRAND CONCOURSE
BRONX NY
10457-7606
US

IV. Provider business mailing address

400 E 84TH ST 15 D
NEW YORK NY
10028-5606
US

V. Phone/Fax

Practice location:
  • Phone: 718-960-1234
  • Fax: 718-960-2055
Mailing address:
  • Phone: 212-600-1249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number189459
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: