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General NPI Number Information
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NPI Number | 1336643865
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Entity Type | Individual
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Provider Name | VIVEK BABU CHITTINENI
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Gender | Male
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Dates
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Enumeration Date | 03/20/2018
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Last Update Date | 06/22/2023
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Provider Practice Location Address
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Address Line | 14700 28TH AVE N STE 20
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City | PLYMOUTH
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State | MN
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Zip | 55447-4876
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Country | US
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Telephone | 763-559-3779
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Fax |
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Provider Business Mailing Address
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Address Line | 4 NIQUETTE CT APT A
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City | WINOOSKI
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State | VT
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Zip | 05404-1854
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Country | US
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Telephone | 952-838-5731
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 042.0016282
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 042-0016282
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License Number State | VT
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 74245
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License Number State | MN
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