Healthcare Provider Details

I. General information

NPI: 1174564124
Provider Name (Legal Business Name): SHANKER CHANDIRAMANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3793 POPLAR LEVEL RD
LOUISVILLE KY
40213-1044
US

IV. Provider business mailing address

PO BOX 950248
LOUISVILLE KY
40295-0248
US

V. Phone/Fax

Practice location:
  • Phone: 502-897-7107
  • Fax: 502-897-7613
Mailing address:
  • Phone: 502-253-1035
  • Fax: 502-253-1037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number27012
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number27012
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: