Basic Information
| Provider Information | |||||||||
| NPI: | 1548299480 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHIMATA | ||||||||
| FirstName: | YUGANDHAR | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2811 DUKE OF GLOUCESTER | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | DESOTO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722745555 | ||||||||
| FaxNumber: | 9722745663 | ||||||||
| Practice Location | |||||||||
| Address1: | 2811 DUKE OF GLOUCESTER | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | DESOTO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722745555 | ||||||||
| FaxNumber: | 9722745663 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2006 | ||||||||
| LastUpdateDate: | 01/26/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | L7332 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 173547401 | 05 | TX | MEDICAID |