Provider Demographics
NPI:1356441489
Name:MILAN S. CHAKRABARTY M.D. INC
Entity Type:Organization
Organization Name:MILAN S. CHAKRABARTY M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MILAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHAKRABARTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-652-2252
Mailing Address - Street 1:PO BOX 5400
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92544-0400
Mailing Address - Country:US
Mailing Address - Phone:951-929-6260
Mailing Address - Fax:951-765-2855
Practice Address - Street 1:1003 E FLORIDA AVE
Practice Address - Street 2:# 101
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4510
Practice Address - Country:US
Practice Address - Phone:951-652-2252
Practice Address - Fax:951-652-3173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36675207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0060110Medicaid
CAGR0060110Medicaid
CAMMM00086MMedicare ID - Type Unspecified