MEDICARE: DR. CHANDRASHEKAR YESHLUR 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	208000000X	Pediatrics Physician	6946A	WY

General Provider Information

NPI Number	:	1528065133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHANDRASHEKAR YESHLUR M.D

Provider Business Mailing Address
First Line	:	1204 HILLTOP DR
Second Line	:	SUITE # 106
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82901-5861
Country	:	US
Telephone Number	:	307-362-5500
Fax Number	:	307-362-0300

Provider Business Practice Location Address
First Line	:	1204 HILLTOP DR
Second Line	:	SUITE # 106
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82901-5861
Country	:	US
Telephone Number	:	307-362-5500
Fax Number	:	307-362-0300

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

Provider Enumeration Date	:	06/29/2005
Last Update Date	:	07/08/2007

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