Provider Demographics
NPI:1376627810
Name:SINGH THETHI, CHANDAN (M D)
Entity Type:Individual
Prefix:
First Name:CHANDAN
Middle Name:
Last Name:SINGH THETHI
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 N MARLIN DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-1536
Mailing Address - Country:US
Mailing Address - Phone:765-662-7454
Mailing Address - Fax:
Practice Address - Street 1:1605 W KEM RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-1735
Practice Address - Country:US
Practice Address - Phone:765-668-8800
Practice Address - Fax:765-668-8814
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01034323204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100123880Medicaid
IND69526Medicare UPIN
IN100123880Medicaid