Healthcare Provider Details

I. General information

NPI: 1710095526
Provider Name (Legal Business Name): CHANDY V GEORGE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 N 35TH ST
MILWAUKEE WI
53208-3872
US

IV. Provider business mailing address

635 N 35TH ST
MILWAUKEE WI
53208-3872
US

V. Phone/Fax

Practice location:
  • Phone: 414-344-5040
  • Fax: 414-344-7051
Mailing address:
  • Phone: 414-344-5040
  • Fax: 414-344-7051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number20257
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: