Individual
SRINIVASACHARI TATADESIKA CHAKRAVARTHI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2222 CHERRY ST, SUITE M200, TOLEDO, OH 43608-2673
(419) 251-8019
(419) 251-5819
Mailing address
2200 JEFFERSON AVE, TOLEDO, OH 43604-7101
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
35085008
OH
207T00000X
Neurological Surgery Physician
4301084746
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0132377
—
OH
01
—
0999980
BAY HEALTH PLAN
MI
01
—
1013097
MCLAREN HEALTH PLAN
MI
01
—
1400910402
BCBSM
MI
05
—
4685161
—
MI
05
—
4753593
—
MI
05
—
4753637
—
MI
01
—
700Z946010
BCBSM
MI
01
—
7344665
AETNA
MI
Enumeration date
03/01/2006
Last updated
09/17/2015
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