Provider Demographics
NPI:1285846576
Name:VENKATA, CHAKRADHAR V (MD)
Entity type:Individual
Prefix:
First Name:CHAKRADHAR
Middle Name:V
Last Name:VENKATA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CHAKRADHAR
Other - Middle Name:VENKATA KRISHNA
Other - Last Name:VENKATA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:625 S NEW BALLAS RD STE 7020
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8218
Mailing Address - Country:US
Mailing Address - Phone:314-251-6486
Mailing Address - Fax:
Practice Address - Street 1:625 S NEW BALLAS RD STE 7020
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8218
Practice Address - Country:US
Practice Address - Phone:314-251-6486
Practice Address - Fax:314-251-4155
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013027481207RC0200X
MN103813207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNENROLLEDMedicaid
MNENROLLEDMedicaid