Healthcare Provider Details

I. General information

NPI: 1013934710
Provider Name (Legal Business Name): LINGAIAH CHANDRASHEKAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 05/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 MEDICAL CENTER DR STE 308
PADUCAH KY
42003
US

IV. Provider business mailing address

2200 JEFFERSON AVE FL 5
TOLEDO OH
43604-7102
US

V. Phone/Fax

Practice location:
  • Phone: 270-443-0777
  • Fax: 270-443-0999
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD39482
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number01058085A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number52067
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: