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General NPI Number Information
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NPI Number | 1447403936
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Entity Type | Organization
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Legal Business Name | CHOUDARY V. KAVURI MD, SC
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Dates
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Enumeration Date | 10/28/2008
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Last Update Date | 09/13/2013
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Provider Practice Location Address
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Address Line | 1770 E LAKE SHORE DR SUITE 208
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City | DECATUR
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State | IL
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Zip | 62521-3832
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Country | US
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Telephone | 217-428-1900
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Fax | 217-428-0358
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Provider Business Mailing Address
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Address Line | 1770 E LAKE SHORE DR STE 208
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City | DECATUR
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State | IL
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Zip | 62521-3839
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Country | US
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Telephone | 217-428-1900
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Fax | 217-428-0358
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. SUNITHA KAVURI
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Credential |
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Telephone | 217-428-1900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036072000
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License Number State | IL
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