MEDICARE: DR. PRASAD K. CHODE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	A50528	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00A505280	OTHER	CA	MEDI CAL #

General Provider Information

NPI Number	:	1194720847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PRASAD K. CHODE MD

Provider Business Mailing Address
First Line	:	3650 E. SOUTH ST.
Second Line	:	STE 303
City	:	LAKEWOOD
State	:	CA
Zip	:	90712
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3650 E. SOUTH ST.
Second Line	:	STE 303
City	:	LAKEWOOD
State	:	CA
Zip	:	90712
Country	:	US
Telephone Number	:	562-923-4911
Fax Number	:	562-904-2060

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2005
Last Update Date	:	10/29/2012

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