Provider Demographics
NPI:1487827853
Name:CHANIN, LOUIS R (DO)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:R
Last Name:CHANIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 PHYSICIANS LN
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-6122
Mailing Address - Country:US
Mailing Address - Phone:662-349-0707
Mailing Address - Fax:
Practice Address - Street 1:60 PHYSICIANS LN
Practice Address - Street 2:SUITE 1
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-6122
Practice Address - Country:US
Practice Address - Phone:662-349-0707
Practice Address - Fax:662-349-0708
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO00791207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3305311Medicare PIN