Provider Demographics
NPI:1124104989
Name:CHIKKALA, JANE SHANTHI (MD)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:SHANTHI
Last Name:CHIKKALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4126 N HOLLAND SYLVANIA RD STE 220
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-3537
Mailing Address - Country:US
Mailing Address - Phone:419-517-7600
Mailing Address - Fax:419-517-7610
Practice Address - Street 1:3020 N MCCORD RD STE 100
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-1701
Practice Address - Country:US
Practice Address - Phone:419-517-7658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.089043208000000X
MI4301088975208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2876213Medicaid