Srutha Keerthi Chebolu

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019.032686 Issued in IL

Practice address

401 N Veterans Pkwy Ste 4
Bloomington, IL 61704-7716

Phone

(309) 808-1317

NPI assigned

Jun 10, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1591747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591747200000",
    "number": "1326663873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 N VETERANS PKWY STE 4",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617047716",
            "telephone_number": "309-808-1317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 N VETERANS PKWY STE 4",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617047716",
            "telephone_number": "309-808-1317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHEBOLU",
        "first_name": "SRUTHA KEERTHI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-10",
        "last_updated": "2020-06-10",
        "certification_date": "2020-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019.032686",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sage Chapman
• Ajit N Chary, M.D.
• Angela Christina Chasensky, PC
• Sydney Chasten
• Madhumita Chatterjee, MD
• Checker Cab of Bloomington, Inc
• Chelsie Carnes Counseling PLLC
• Rebecca W Cherry
• Chesntut Health Systems, Inc.
• Chesntut Health Systems, Inc. (Chestnut Family Health Center)

• General Practice Dentistry in Bloomington, IL
• Providers in Bloomington, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.