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General NPI Number Information
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NPI Number | 1164525952
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Entity Type | Individual
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Provider Name | VENKATA K CHALASANI M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/07/2006
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Last Update Date | 08/05/2020
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Provider Practice Location Address
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Address Line | 812 REDSKIN TRL STE A WAPAKONETA PRIMARY CARE
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City | WAPAKONETA
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State | OH
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Zip | 45895-8545
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Country | US
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Telephone | 419-738-4445
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Fax | 419-738-4601
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Provider Business Mailing Address
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Address Line | 200 SAINT CLAIR AVE JTDM FAMILY PRACTICE, LLC
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City | SAINT MARYS
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State | OH
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Zip | 45885-2400
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Country | US
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Telephone | 419-394-3387
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Fax | 419-738-4601
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35074822
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License Number State | OH
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