Individual
SRUJANA CHAKILAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1017 12TH AVE, FORT WORTH, TX 76104-3915
(817) 334-2800
(817) 820-0094
Mailing address
1017 12TH AVE, FORT WORTH, TX 76104-3915
(817) 334-2800
(817) 820-0094
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
P7409
TX
207RC0000X
Cardiovascular Disease Physician
Primary
P7409
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
327590101
—
TX
Enumeration date
01/14/2009
Last updated
12/07/2021
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