Provider Demographics
NPI:1235662735
Name:SANWAL, CHANDRA PRAKASH (DO)
Entity Type:Individual
Prefix:
First Name:CHANDRA
Middle Name:PRAKASH
Last Name:SANWAL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20614 STONE OAK PKWY
Mailing Address - Street 2:APT 312
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258
Mailing Address - Country:US
Mailing Address - Phone:813-760-9742
Mailing Address - Fax:
Practice Address - Street 1:7000 SW 62ND AVE STE 401
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4721
Practice Address - Country:US
Practice Address - Phone:305-284-7594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-11
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXR9682207RH0000X, 207RX0202X, 207R00000X
FLOS17247207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine