Healthcare Provider Details

I. General information

NPI: 1568430874
Provider Name (Legal Business Name): GAGAN S CHADHA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2006
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 SAGAMORE PKWY W
WEST LAFAYETTE IN
47906-1569
US

IV. Provider business mailing address

PO BOX 4699
LAFAYETTE IN
47903-4699
US

V. Phone/Fax

Practice location:
  • Phone: 765-497-2428
  • Fax: 765-497-4251
Mailing address:
  • Phone: 765-449-2732
  • Fax: 765-449-1196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01048719A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: