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Individual

CHAITANYA UNDAVALLI

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
2900 E TEXAS ST STE 100, BOSSIER CITY, LA 71111-3275
(318) 606-6737
(833) 749-0343
Mailing address
6101 BLUE LAGOON DR STE 200, MIAMI, FL 33126-3168
(844) 630-0700
(877) 374-1924

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
343550
LA
390200000X
Student in an Organized Health Care Education/Training Program
BP20085227
TX

Other

Enumeration date
05/05/2020
Last updated
04/14/2026
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