MEDICARE: DR. CHAITANYA VENKATA TUMMALA 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	207RI0200X	Infectious Disease Physician	L9525	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	:	1518929959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHAITANYA VENKATA TUMMALA MD

Provider Business Mailing Address
First Line	:	4461 COIT RD STE 409
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75035-0526
Country	:	US
Telephone Number	:	214-396-8877
Fax Number	:	214-983-0983

Provider Business Practice Location Address
First Line	:	4461 COIT RD
Second Line	:	STE 409
City	:	FRISCO
State	:	TX
Zip	:	75035-0526
Country	:	US
Telephone Number	:	214-396-8877
Fax Number	:	214-983-0983

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

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	02/29/2024

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