Healthcare Provider Details

I. General information

NPI: 1972878346
Provider Name (Legal Business Name): KUTTY K CHANDRAN, MD, PA.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2012
Last Update Date: 03/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10161 W SAMPLE RD SUITE B
CORAL SPRINGS FL
33065-3954
US

IV. Provider business mailing address

10161 W SAMPLE RD SUITE B
CORAL SPRINGS FL
33065-3954
US

V. Phone/Fax

Practice location:
  • Phone: 954-755-6400
  • Fax: 954-753-5172
Mailing address:
  • Phone: 954-755-6400
  • Fax: 954-753-5172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberME54935
License Number StateFL

VIII. Authorized Official

Name: DR. KUTTY K CHANDRAN
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 954-755-6400