Provider Demographics
NPI:1588866297
Name:MUSHAM, CHAITANYA KUMAR (MD)
Entity type:Individual
Prefix:DR
First Name:CHAITANYA
Middle Name:KUMAR
Last Name:MUSHAM
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:401 N CARROLL AVE STE 440
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6407
Mailing Address - Country:US
Mailing Address - Phone:501-552-4677
Mailing Address - Fax:501-552-4555
Practice Address - Street 1:2 SAINT VINCENT CIR FL 3
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5423
Practice Address - Country:US
Practice Address - Phone:501-552-4677
Practice Address - Fax:501-552-4555
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2025-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXQ3927207R00000X
ARE-6956207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5AK67Medicare PIN