Healthcare Provider Details

I. General information

NPI: 1639331820
Provider Name (Legal Business Name): PRAKASH CHANDRA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2008
Last Update Date: 10/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W 19TH TER TRUMAN MEDICAL CENTER BEHAVIORAL HEALTH
KANSAS CITY MO
64108-2026
US

IV. Provider business mailing address

2310 HOLMES ST STE 800
KANSAS CITY MO
64108-2602
US

V. Phone/Fax

Practice location:
  • Phone: 816-404-5700
  • Fax:
Mailing address:
  • Phone: 816-218-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2013008756
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number2013008756
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: