Individual
KRISHNABABU CHUNDURI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
713 GRAINGER STREET, FORT WORTH, TX 76104-7400
(817) 336-3968
(817) 336-3917
Mailing address
713 GRAINGER STREET, FORT WORTH, TX 76104-7400
(817) 336-3968
(817) 336-3917
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
G0378
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00TE62
BLUE CROSS BLUE SHIELD
TX
05
—
127931703
—
TX
01
—
C14487
CHAMPUS/TRICARE
TX
Enumeration date
09/13/2005
Last updated
10/10/2011
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