Healthcare Provider Details

I. General information

NPI: 1922092030
Provider Name (Legal Business Name): VIDYA T CHANDE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VIDYA BALKRISHNA SUKHATME

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 PLEASANT ST BLANK CHILDRENS HOSPITAL
DES MOINES IA
50309-1406
US

IV. Provider business mailing address

1200 PLEASANT ST BLANK CHILDRENS HOSPITAL
DES MOINES IA
50309-1406
US

V. Phone/Fax

Practice location:
  • Phone: 515-241-5926
  • Fax: 515-241-5127
Mailing address:
  • Phone: 515-241-5926
  • Fax: 515-241-5127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number33479
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: