Basic Information
| Provider Information | |||||||||
| NPI: | 1871757963 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHEBROLU | ||||||||
| FirstName: | LAKSHMI | ||||||||
| MiddleName: | HIMA BINDU | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8520 BROADWAY ST | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | PEARLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775847716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134419909 | ||||||||
| FaxNumber: | 2814857305 | ||||||||
| Practice Location | |||||||||
| Address1: | 8520 BROADWAY ST | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | PEARLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775847716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134419909 | ||||||||
| FaxNumber: | 2814857305 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2008 | ||||||||
| LastUpdateDate: | 08/31/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MT193281 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | Q2981 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 366648902 | 05 | TX | MEDICAID | 366648901 | 05 | TX | MEDICAID | 8GJ470 | 01 | TX | BCBS | OTHER |