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General NPI Number Information
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NPI Number | 1114101904
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Entity Type | Individual
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Provider Name | CHAITHANYA MALLIKARJUN MD
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Gender | Female
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Dates
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Enumeration Date | 12/28/2007
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Last Update Date | 11/20/2014
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Provider Practice Location Address
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Address Line | 19284 STONE OAK PKWY 104
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City | SAN ANTONIO
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State | TX
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Zip | 78258-3473
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Country | US
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Telephone | 210-268-0124
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Fax |
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Provider Business Mailing Address
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Address Line | 19284 STONE OAK PKWY 104
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City | SAN ANTONIO
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State | TX
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Zip | 78258-3473
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Country | US
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Telephone | 210-598-4730
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Fax |
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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 | 207RI0008X
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Taxonomy Name | Hepatology Physician
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License Number | MD.201765
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | P9220
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License Number State | TX
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