MEDICARE: CHANUKYA SURESH CHERUKURI 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	390200000X	Student in an Organized Health Care Education/Training Program		MS

General Provider Information

NPI Number	:	1144173121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANUKYA SURESH CHERUKURI MD

Provider Business Mailing Address
First Line	:	2500 N STATE ST
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39216-4500
Country	:	US
Telephone Number	:	601-984-5012
Fax Number	:

Provider Business Practice Location Address
First Line	:	802 LAKELAND DR APT 416
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39216-4628
Country	:	US
Telephone Number	:	601-954-7448
Fax Number	:

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

Provider Enumeration Date	:	02/18/2026
Last Update Date	:	02/18/2026

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