Basic Information
| Provider Information | |||||||||
| NPI: | 1932168143 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHITTAJALLU | ||||||||
| FirstName: | RAVI | ||||||||
| MiddleName: | SHANKAR | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7610 N STEMMONS FWY STE 600 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752474228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146895960 | ||||||||
| FaxNumber: | 4697138084 | ||||||||
| Practice Location | |||||||||
| Address1: | 4521 MEDICAL CENTER DR | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | MCKINNEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750691651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9725628383 | ||||||||
| FaxNumber: | 9725488388 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2006 | ||||||||
| LastUpdateDate: | 09/25/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | L2844 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 8G9580 | 01 | TX | BCBSTX | OTHER | 154584001 | 05 | TX | MEDICAID |