MEDICARE: PREM K.G. CHANDRAN M.D.

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	207RN0300X	Nephrology Physician	24158	IA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00329636	OTHER	IA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1518969104	OTHER	IA	WELLMARK BCBS
3	13649	OTHER	IA	WELLMARK BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518969104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PREM K.G. CHANDRAN M.D.

Provider Business Mailing Address
First Line	:	411 LAUREL ST STE 2350
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50314-3026
Country	:	US
Telephone Number	:	515-280-4700
Fax Number	:	515-280-4701

Provider Business Practice Location Address
First Line	:	411 LAUREL ST, SUITE 2350
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50314
Country	:	US
Telephone Number	:	515-280-4700
Fax Number	:	515-280-4701

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

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	01/07/2015

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Directions to “ PREM K.G. CHANDRAN M.D.” Practice Location

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