Provider Demographics
NPI:1295099406
Name:CHILLURU, VAMSI KRISHNA (MBBS)
Entity type:Individual
Prefix:DR
First Name:VAMSI KRISHNA
Middle Name:
Last Name:CHILLURU
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 CEDAR CT
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-5336
Mailing Address - Country:US
Mailing Address - Phone:618-529-2955
Mailing Address - Fax:618-457-7823
Practice Address - Street 1:1350 CEDAR CT
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-5336
Practice Address - Country:US
Practice Address - Phone:618-529-2955
Practice Address - Fax:618-457-7823
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018010267208M00000X
IL036156322207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist