SRUJANA CHAKILAM (NPI# 1629215587) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629215587 |
| Entity Type | Individual |
| Full Name | SRUJANA CHAKILAM |
| Credential | M.D. |
| Practice Address |
1017 12th Ave Fort Worth TX 76104-3915 |
| Practice Telephone | 8173342800 |
| Practice Fax Number | 8178200094 |
| Mailing Telephone | 8173342800 |
| Mailing Fax Number | 8178200094 |
| Enumeration Date | 2009-01-14 |
| Last Update Date | 2020-01-15 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | 4301087249 | MI | Allopathic & Osteopathic Physicians |
| Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
P7409 | TX | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | BLUE CROSS BLUE SHIELD | 700Q262160 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1400 8th Ave, Fort Worth, TX 761044110 | 8179276224 | 8179276226 |
| Street Address |
1017 12TH AVE |
| City | FORT WORTH |
| State | TX |
| Zip Code | 76104-3915 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619927373 | George Souhel Khammar | Internal Medicine | 1017 12th Ave, Fort Worth, TX 76104-3915 | 2006-05-11 |
| 1215589726 | Tracy Linn Eisenhauer Dilley | Nurse Practitioner | 1017 12th Ave, Fort Worth, TX 76104-3915 | 2019-07-15 |
| 1639615347 | Alla Havens | Nurse Practitioner | 1017 12th Ave, Fort Worth, TX 76104-3915 | 2017-01-18 |
| 1063816833 | Danielle L King | Physician Assistant | 1017 12th Ave, Fort Worth, TX 76104 | 2014-10-22 |
| 1629403712 | Kathryn Elizabeth Marcinowski | Physician Assistant | 1017 12th Ave, Fort Worth, TX 76104-3915 | 2013-09-07 |
| 1821339201 | Isadora Galindo Subia | Nurse Practitioner | 1017 12th Ave, Fort Worth, TX 76104-3915 | 2013-03-08 |
| 1558659607 | Carrie S Platt | Nurse Practitioner | 1017 12th Ave, Fort Worth, TX 76104-3915 | 2011-07-11 |
| 1770804981 | Aleem Iqbal Mughal | Internal Medicine | 1017 12th Ave, Fort Worth, TX 76104-3915 | 2010-06-22 |
| 1770710543 | Cyril Varughese | Internal Medicine | 1017 12th Ave, Fort Worth, TX 76104-3915 | 2009-06-18 |
| 1437397478 | Akif Azmi Mohammed | Internal Medicine | 1017 12th Ave, Fort Worth, TX 76104-3915 | 2009-01-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669082186 | Cvs Pharmacy, Inc. | Durable Medical Equipment & Medical Supplies | 1115 8th St, Fort Worth, TX 76104 | 2020-08-10 |
| 1992343693 | Iris Giove | Psychologist | John Peter Smith Hospital, 1500 S. Main St., Fort Worth, TX 76104 | 2019-12-13 |
| 1104480656 | Swarnalaxmi Umapathy | Student in an Organized Health Care Education/Training Program | 900 8th Avenue, Fort Worth, TX 76104 | 2019-04-30 |
| 1881189132 | Mega Surgical Assistants LLC | Specialist/Technologist, Other | 1301pennsylvania, Fort Worth, TX 76104 | 2018-06-28 |
| 1356848899 | Tricia Kelly | Nurse Practitioner | 1325 Pennsylvania Avenue Suite 560, Fort Worth, TX 76104 | 2018-04-11 |
| 1952820979 | Modern Vein Clinic | Internal Medicine | 757 8th Avenue, Suite A, Forth Worth, TX 76104 | 2017-09-11 |
| 1790207165 | Vanessa Abbood | Dietitian, Registered | 900 Eighth Ave, Fns Department, Fort Worth, TX 76104 | 2017-07-07 |
| 1922537562 | Nicole Marie Tod | Student in an Organized Health Care Education/Training Program | 1500 S Main Street, Fort Worth, TX 76104 | 2017-06-07 |
| 1770025934 | Micah Bonola | Chiropractor | 1300 W. Rosedale St, Ste. A, Fort Worth, TX 76104 | 2016-11-04 |
| 1518315894 | United Bioscience, LLC. | Clinical Medical Laboratory | 901 W. Leuda St., B, Fort Worth, TX 76104 | 2016-05-27 |
| Find all providers in zip 76104 | ||||
| Taxonomy Code | 207RC0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Cardiovascular Disease |
| An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083195648 | Ff Corporation Pllc | Internal Medicine | 7100 Oakmont Blvd Ste No201, Fort Worth, TX 76132-3900 | 2018-08-22 |
| 1376918292 | Makd Heart & Vascular LLC | Internal Medicine | 1401 8th Avenue, Fort Worth, TX 76104-3915 | 2015-12-03 |
| 1528436565 | Davinci Medical, LLC | Internal Medicine | 6809 Sawgrass Dr, Fort Worth, TX 76132-7103 | 2015-09-08 |
| 1831485192 | Fahmi Jasmin Farah | Internal Medicine | 7100 Oakmont Blvd Ste 201, Fort Worth, TX 76132-3908 | 2011-06-24 |
| 1659664100 | Pro Health Diagnostics of North Texas Pa | Internal Medicine | 1904 Canterbury Drive, Fort Worth, TX 76107-3514 | 2011-05-17 |
| 1396936357 | Farhan Ali | Internal Medicine | 1017 12th Avenue, Fort Worth, TX 76104-0000 | 2007-08-06 |
| 1619021714 | Benedict Anthony Termini | Internal Medicine | 8520 Meadowbrook Dr, Fort Worth, TX 76120-5204 | 2007-01-23 |
| 1932294469 | Saritha Dodla | Internal Medicine | 4324 Heritage Trace Pkwy, Ste 808, Fort Worth, TX 76244-9127 | 2006-10-03 |
| 1316039795 | Muhammad A Qureshi | Internal Medicine | 3403 N Beach St, Fort Worth, TX 76111-6305 | 2006-09-29 |
| 1134233588 | Mohanakrishnan Sathyamoorthy | Internal Medicine | 1121 5th Ave Ste 100, Fort Worth, TX 76104-4386 | 2006-08-19 |
| Find all providers in FORT WORTH | ||||
| City | FORT WORTH |
| Zip Code | 76104 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.