Provider Demographics
NPI:1265508634
Name:MALHOTRA, CHANDER KAMAL (MD)
Entity Type:Individual
Prefix:DR
First Name:CHANDER
Middle Name:KAMAL
Last Name:MALHOTRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:580-616-7630
Mailing Address - Fax:580-237-7516
Practice Address - Street 1:707 S MONROE ST
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-7286
Practice Address - Country:US
Practice Address - Phone:580-616-7630
Practice Address - Fax:580-237-7516
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14193207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100041310AMedicaid
OK100041310AMedicaid
C95202Medicare UPIN
OKOKAAA1735Medicare PIN