MEDICARE: CHANDAN LAD M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	21976	OK

General Provider Information

NPI Number	:	1164409025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANDAN LAD M.D.

Provider Business Mailing Address
First Line	:	6600 S YALE AVE
Second Line	:	STE 1400
City	:	TULSA
State	:	OK
Zip	:	74136-3310
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3218 S 79TH EAST AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74145-1316
Country	:	US
Telephone Number	:	918-728-6880
Fax Number	:	918-728-6881

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2005
Last Update Date	:	09/21/2015

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