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General NPI Number Information
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NPI Number | 1205800257
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Entity Type | Individual
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Provider Name | SUNIL GUPTA CHAND MD
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Gender | Male
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Dates
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Enumeration Date | 02/15/2006
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Last Update Date | 03/12/2014
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Provider Practice Location Address
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Address Line | 1031 E KARSCH BLVD
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City | FARMINGTON
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State | MO
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Zip | 63640-3404
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Country | US
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Telephone | 573-756-7880
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 107 1031 EAST KARSCH BLVD
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City | FARMINGTON
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State | MO
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Zip | 63640-0107
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Country | US
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Telephone | 573-756-7880
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 109266
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License Number State | MO
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