Individual
CHAKRADHAR DESARAJU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6201 N SUNCOAST BLVD, CRYSTAL RIVER, FL 34428-6712
(352) 795-6560
Mailing address
3533 N LECANTO HWY, BEVERLY HILLS, FL 34465-3501
(352) 795-6560
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME93164
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
280320800
—
FL
01
—
29576
BCBS OF FL
FL
01
—
9010415
CIGNA
FL
01
—
ME93164
STATE LICENSSE NUMBER
FL
01
—
P00294598
MEDICARE RR
FL
Enumeration date
11/29/2005
Last updated
07/09/2021
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