Provider Demographics
NPI:1629242714
Name:KUNDAVARAM, CHANDAN R (MD)
Entity Type:Individual
Prefix:DR
First Name:CHANDAN
Middle Name:R
Last Name:KUNDAVARAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:14044 W CAMELBACK RD
Mailing Address - Street 2:STE 118
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-9428
Mailing Address - Country:US
Mailing Address - Phone:623-547-2600
Mailing Address - Fax:623-574-1899
Practice Address - Street 1:14044 W CAMELBACK RD
Practice Address - Street 2:STE 118 & 216
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-9428
Practice Address - Country:US
Practice Address - Phone:623-547-2600
Practice Address - Fax:623-574-1899
Is Sole Proprietor?:No
Enumeration Date:2008-04-18
Last Update Date:2015-08-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMT190920208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology