Healthcare Provider Details

I. General information

NPI: 1447623590
Provider Name (Legal Business Name): RAHUL B. CHANDAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RAHUL BRIJBALLABH CHANDAK MD

II. Dates (important events)

Enumeration Date: 11/10/2015
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2670 CHANCELLOR DR
CRESTVIEW HILLS KY
41017-5466
US

IV. Provider business mailing address

PO BOX 635283
CINCINNATI OH
45263-5283
US

V. Phone/Fax

Practice location:
  • Phone: 859-957-0052
  • Fax: 859-957-0054
Mailing address:
  • Phone: 859-344-5555
  • Fax: 859-344-5552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number58567
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: