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General NPI Number Information
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NPI Number | 1407951882
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Entity Type | Individual
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Provider Name | MOHAN M CHILUKURI MD
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Gender | Male
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 09/28/2023
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Provider Practice Location Address
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Address Line | 2400 BROAD ST SUITE 1
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City | DURHAM
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State | NC
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Zip | 27704-2661
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Country | US
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Telephone | 919-220-9800
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Fax | 919-220-9500
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Provider Business Mailing Address
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Address Line | 4705 UNIVERSITY DR BLDG 700
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City | DURHAM
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State | NC
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Zip | 27707-3489
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Country | US
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Telephone | 919-237-1337
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Fax | 919-237-1625
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 9300061
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License Number State | NC
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