| Choudary V. Kavuri Md, Sc | |
|
1770 E Lake Shore Dr Suite 208 Decatur IL 62521-3832 | |
| (217) 428-1900 | |
| (217) 428-0358 |
| Full Name | Choudary V. Kavuri Md, Sc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1770 E Lake Shore Dr, Decatur, Illinois |
| Authorized Official Name and Position | Sunitha Kavuri (OFFICE MANAGER) |
| Authorized Official Contact | 2174281900 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Choudary V. Kavuri Md, Sc 1770 E Lake Shore Dr Ste 208 Decatur IL 62521-3839 Ph: (217) 428-1900 | Choudary V. Kavuri Md, Sc 1770 E Lake Shore Dr Suite 208 Decatur IL 62521-3832 Ph: (217) 428-1900 |
| NPI Number | 1447403936 |
|---|---|
| Provider Enumeration Date | 10/28/2008 |
| Last Update Date | 09/13/2013 |
| Medicare PECOS PAC ID | 1759415771 |
|---|---|
| Medicare Enrollment ID | O20100812000815 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447403936 | NPI | - | NPPES |
| 05821917 | Other | IL | BCBS |
| 036072000 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 036072000 (Illinois) | Primary |
| Provider Name | Choudary V Kavuri |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1770642159 PECOS PAC ID: 8325019672 Enrollment ID: I20040802001172 |
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