Provider Demographics
NPI:1447286984
Name:CHAKINALA, CHANDRAMOULI (MD)
Entity type:Individual
Prefix:
First Name:CHANDRAMOULI
Middle Name:
Last Name:CHAKINALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3202 HAMILTON BLVD
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-2025
Mailing Address - Country:US
Mailing Address - Phone:940-322-9390
Mailing Address - Fax:940-322-2341
Practice Address - Street 1:2200 9TH ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-4029
Practice Address - Country:US
Practice Address - Phone:940-723-4134
Practice Address - Fax:940-322-2341
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF0413174400000X, 207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No174400000XOther Service ProvidersSpecialist
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133076305Medicaid
TX133076305Medicaid
TXC14331Medicare UPIN