Healthcare Provider Details

I. General information

NPI: 1730133547
Provider Name (Legal Business Name): RAVI THEETHAKARAI CHANDRAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1951 N WILMOT RD BLDG 4
TUCSON AZ
85712-8001
US

IV. Provider business mailing address

1951 N WILMOT RD BLDG 4
TUCSON AZ
85712-8001
US

V. Phone/Fax

Practice location:
  • Phone: 520-318-1114
  • Fax:
Mailing address:
  • Phone: 520-318-1114
  • Fax: 520-318-4693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number23128
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number23128
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number72622
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: