MEDICARE: MANJULA 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	207Q00000X	Family Medicine Physician	M4734	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01263455	OTHER	TX	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8DL155	OTHER	TX	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477632016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANJULA CHERUKURI MD

Provider Business Mailing Address
First Line	:	202 S AKARD ST STE PC-50
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75202-4206
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	208 S AKARD ST STE PC-50
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75202-4206
Country	:	US
Telephone Number	:	469-490-3119
Fax Number	:

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

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	03/12/2024

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