Provider Demographics
NPI:1134412901
Name:CHERUKURI, CHANDRA MOULI (MD, MS)
Entity type:Individual
Prefix:DR
First Name:CHANDRA
Middle Name:MOULI
Last Name:CHERUKURI
Suffix:
Gender:M
Credentials:MD, MS
Other - Prefix:
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Mailing Address - Street 1:701 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1623
Mailing Address - Country:US
Mailing Address - Phone:763-873-3000
Mailing Address - Fax:612-873-1928
Practice Address - Street 1:2810 NICOLLET AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-4708
Practice Address - Country:US
Practice Address - Phone:612-873-6963
Practice Address - Fax:612-545-9049
Is Sole Proprietor?:No
Enumeration Date:2011-05-26
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN57381207Q00000X, 207QG0300X, 207QS1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine