Provider Demographics
NPI:1477686301
Name:CHANDRAKAR, KUNJEELAL (MD)
Entity Type:Individual
Prefix:
First Name:KUNJEELAL
Middle Name:
Last Name:CHANDRAKAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12015 LOUETTA RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-1148
Mailing Address - Country:US
Mailing Address - Phone:281-370-7272
Mailing Address - Fax:
Practice Address - Street 1:12015 LOUETTA RD
Practice Address - Street 2:SUITE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-1148
Practice Address - Country:US
Practice Address - Phone:281-370-7272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1869208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPOOOTW411Medicaid
TXB76157Medicare UPIN
TXTXB152916Medicare PIN
TX00TW41Medicare ID - Type Unspecified