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General NPI Number Information
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NPI Number | 1629165899
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Entity Type | Individual
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Provider Name | SHARADA KAMALANATHA CHAITRA MD
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Gender | Female
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 03/28/2018
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Provider Practice Location Address
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Address Line | 1910 SOUTH AVE
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City | LA CROSSE
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State | WI
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Zip | 54601-5467
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Country | US
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Telephone | 608-782-7300
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Fax |
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Provider Business Mailing Address
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Address Line | 12222 BEVERLY STREET
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City | OVERLAND PARK
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State | KS
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Zip | 66209
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Country | US
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Telephone | 913-451-9093
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 31452
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 036-075446
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License Number State | IL
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