Healthcare Provider Details

I. General information

NPI: 1265445662
Provider Name (Legal Business Name): SUSHMA CHANDAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 01/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 ABRAHAM FLEXNER WAY STE 1200
LOUISVILLE KY
40202
US

IV. Provider business mailing address

PO BOX 909
LOUISVILLE KY
40201-0909
US

V. Phone/Fax

Practice location:
  • Phone: 502-584-3377
  • Fax: 502-584-3480
Mailing address:
  • Phone: 502-899-3623
  • Fax: 502-899-7970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number022984
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number50829
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: