Provider Demographics
NPI:1225065220
Name:CHANDRA, RAKESH (MD)
Entity Type:Individual
Prefix:DR
First Name:RAKESH
Middle Name:
Last Name:CHANDRA
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 1:1155 CEDAR CT
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-5333
Mailing Address - Country:US
Mailing Address - Phone:618-490-1045
Mailing Address - Fax:618-319-1279
Practice Address - Street 1:1099 MEDICAL CENTER CIRCLE
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066
Practice Address - Country:US
Practice Address - Phone:618-201-6996
Practice Address - Fax:618-998-1328
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360932402084P0800X
KY37163103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCF3444OtherMEDICARE RR
KY6413098200Medicaid
IL370966854011Medicaid
KY64130982Medicaid
KYP00464595OtherRR MEDICARE PIN #
KYP00830780OtherRR MEDICARE
IL370966854006Medicaid
IL370966854023Medicaid
IL370966854024Medicaid
IL036093240Medicaid
IL141967Medicare Oscar/Certification
KY64130982Medicaid
IL370966854011Medicaid
KY0450740Medicare UPIN
IL141112Medicare Oscar/Certification
KY6413098200Medicaid
IL370966854006Medicaid
IL370966854023Medicaid
KY1970601Medicare PIN