Healthcare Provider Details

I. General information

NPI: 1013240043
Provider Name (Legal Business Name): CHANDRASHISH CHAKRAVARTY M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 09/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NW 10TH AVE APT 2009
MIAMI FL
33136-1000
US

IV. Provider business mailing address

1400 NW 10TH AVE APT 2009
MIAMI FL
33136-1000
US

V. Phone/Fax

Practice location:
  • Phone: 305-879-2292
  • Fax:
Mailing address:
  • Phone: 305-879-2292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberTRN14096
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: