Provider Demographics
NPI:1457661811
Name:LATCHMAN, CHANDROUTIE (DO)
Entity Type:Individual
Prefix:
First Name:CHANDROUTIE
Middle Name:
Last Name:LATCHMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 N HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:KS
Mailing Address - Zip Code:66743-2000
Mailing Address - Country:US
Mailing Address - Phone:620-724-8291
Mailing Address - Fax:620-724-6332
Practice Address - Street 1:302 N HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:KS
Practice Address - Zip Code:66743-2000
Practice Address - Country:US
Practice Address - Phone:620-724-8291
Practice Address - Fax:620-724-6332
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-19
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-36851208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS05-36851OtherKANSAS LICENSE