Healthcare Provider Details

I. General information

NPI: 1700375706
Provider Name (Legal Business Name): PRAKASH BAHADUR CHAND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2018
Last Update Date: 03/07/2023
Certification Date: 10/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 JACKSON STREET
MONROE LA
71201
US

IV. Provider business mailing address

107 ASHFORD DRIVE APT. 1022
WEST MONROE LA
71291
US

V. Phone/Fax

Practice location:
  • Phone: 318-966-4541
  • Fax: 318-966-4543
Mailing address:
  • Phone: 929-401-6455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number328686
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: