MEDICARE: CHAITHANYA MALLIKARJUN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0008X	Hepatology Physician	MD.201765	LA
2	207RG0100X	Gastroenterology Physician	P9220	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114101904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHAITHANYA MALLIKARJUN MD

Provider Business Mailing Address
First Line	:	19284 STONE OAK PKWY
Second Line	:	104
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-3473
Country	:	US
Telephone Number	:	210-598-4730
Fax Number	:

Provider Business Practice Location Address
First Line	:	19284 STONE OAK PKWY
Second Line	:	104
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-3473
Country	:	US
Telephone Number	:	210-268-0124
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2007
Last Update Date	:	11/20/2014

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