Provider Demographics
NPI:1346256179
Name:CHANDANI, ILLA (MD)
Entity Type:Individual
Prefix:
First Name:ILLA
Middle Name:
Last Name:CHANDANI
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:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-643-2400
Mailing Address - Fax:515-643-4766
Practice Address - Street 1:5900 E UNIVERSITY AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PLEASANT HILL
Practice Address - State:IA
Practice Address - Zip Code:50327-8457
Practice Address - Country:US
Practice Address - Phone:515-643-2400
Practice Address - Fax:515-643-4766
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA34321207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA3248781Medicaid
IAI7019Medicare ID - Type Unspecified
IA3248781Medicaid