Provider Demographics
NPI:1003073461
Name:WASEKAR, CHETAN JIWAN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHETAN
Middle Name:JIWAN
Last Name:WASEKAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 W MURPHY DR
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-3216
Mailing Address - Country:US
Mailing Address - Phone:573-529-6612
Mailing Address - Fax:
Practice Address - Street 1:1325 S CLIFF AVE
Practice Address - Street 2:SUITE 4421
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1007
Practice Address - Country:US
Practice Address - Phone:605-322-7645
Practice Address - Fax:605-322-8414
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
SD8068208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6006843Medicaid
P01099186OtherRR MEDICARE
SDS106194Medicare PIN