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General NPI Number Information
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NPI Number | 1689019648
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Entity Type | Individual
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Provider Name | KRISHNA KARTHIK CHIVUKULA M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/05/2013
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Last Update Date | 06/28/2024
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Provider Practice Location Address
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Address Line | 529 JASMINE ST
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City | OMAK
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State | WA
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Zip | 98841-9589
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Country | US
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Telephone | 509-826-1600
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Fax | 509-826-9277
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Provider Business Mailing Address
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Address Line | 529 JASMINE ST
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City | OMAK
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State | WA
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Zip | 98841-9589
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Country | US
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Telephone | 509-826-1600
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Fax | 509-826-9277
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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 | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | ME127117
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | MD61139841
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD61139841
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME127117
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 207RB0002X
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Taxonomy Name | Obesity Medicine (Internal Medicine) Physician
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License Number | MD61139841
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License Number State | WA
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