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General NPI Number Information
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NPI Number | 1801704754
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Entity Type | Individual
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Provider Name | ANIL KIRAN CHOKKALLA PHD, D(ABCC), NRCC
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Gender | Male
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Dates
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Enumeration Date | 08/31/2026
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Last Update Date | 08/31/2026
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Provider Practice Location Address
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Address Line | 737 BROADWAY N
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City | FARGO
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State | ND
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Zip | 58102-4421
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Country | US
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Telephone | 701-234-2450
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Fax |
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Provider Business Mailing Address
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Address Line | 2920 SHEYENNE ST APT 518
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City | WEST FARGO
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State | ND
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Zip | 58078-6018
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Country | US
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Telephone |
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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 | 246QC1000X
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Taxonomy Name | Chemistry Pathology Specialist/Technologist
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License Number | 1351
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License Number State |
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