Healthcare Provider Details

I. General information

NPI: 1073017828
Provider Name (Legal Business Name): NITEESH CHITTURU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 SCRIPTURE ST STE 100
DENTON TX
76201-2481
US

IV. Provider business mailing address

1402 S GRAND BLVD
SAINT LOUIS MO
63104-1004
US

V. Phone/Fax

Practice location:
  • Phone: 940-320-2188
  • Fax:
Mailing address:
  • Phone: 314-577-8762
  • Fax: 314-268-5108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberV2459
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberV2459
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: