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General NPI Number Information
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NPI Number | 1497742092
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Entity Type | Individual
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Provider Name | SUDHISH CHANDRA MD
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Gender | Male
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Dates
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Enumeration Date | 09/29/2005
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Last Update Date | 07/19/2011
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Provider Practice Location Address
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Address Line | 5454 HOHMAN AVE
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City | HAMMOND
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State | IN
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Zip | 46320-1931
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Country | US
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Telephone | 219-933-2300
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1000
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City | DYER
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State | IN
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Zip | 46311-0800
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Country | US
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Telephone | 219-864-2107
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Fax | 219-864-2649
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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 | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 01059766A
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License Number State | IN
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