Provider Demographics
NPI:1588849228
Name:SHOBHA CHANDRA, MD PLC
Entity Type:Organization
Organization Name:SHOBHA CHANDRA, MD PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHOBHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-698-4000
Mailing Address - Street 1:9229 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:WHITE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48386-2307
Mailing Address - Country:US
Mailing Address - Phone:248-698-4000
Mailing Address - Fax:248-698-1879
Practice Address - Street 1:9229 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:WHITE LAKE
Practice Address - State:MI
Practice Address - Zip Code:48386-2307
Practice Address - Country:US
Practice Address - Phone:248-698-4000
Practice Address - Fax:248-698-1879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301034915208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301034915OtherLICENSE
MI1578662540OtherNPI