Provider Demographics
NPI:1114969573
Name:JAYACHANDRAN, VIJAY (MD)
Entity Type:Individual
Prefix:
First Name:VIJAY
Middle Name:
Last Name:JAYACHANDRAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 45TH AVE
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2818
Mailing Address - Country:US
Mailing Address - Phone:219-934-6410
Mailing Address - Fax:219-924-3143
Practice Address - Street 1:1650 45TH ST STE 2A&2B
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-3962
Practice Address - Country:US
Practice Address - Phone:219-934-6410
Practice Address - Fax:219-924-3143
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01041792A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
INF40928Medicare UPIN
IN100381610AMedicare ID - Type Unspecified
IN407420BMedicare ID - Type Unspecified