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General NPI Number Information
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NPI Number | 1023258043
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Entity Type | Individual
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Provider Name | ANUPAMA CHENNUPATI MD
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Gender | Female
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Dates
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Enumeration Date | 03/03/2009
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Last Update Date | 05/07/2024
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Provider Practice Location Address
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Address Line | 1634 MISTLETOE BLVD
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City | FORT WORTH
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State | TX
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Zip | 76104-4012
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Country | US
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Telephone | 817-818-8433
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Fax | 817-423-7473
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Provider Business Mailing Address
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Address Line | 912 CHARLESTON DR
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City | SOUTHLAKE
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State | TX
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Zip | 76092-1536
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Country | US
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Telephone | 817-818-8433
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Fax | 949-404-6343
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | P5523
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License Number State | TX
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