Provider Demographics
NPI:1669473799
Name:CHANDRAN, KUTTY K (MD)
Entity Type:Individual
Prefix:
First Name:KUTTY
Middle Name:K
Last Name:CHANDRAN
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 1:10161 W SAMPLE RD
Mailing Address - Street 2:STE B
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-3954
Mailing Address - Country:US
Mailing Address - Phone:954-755-6400
Mailing Address - Fax:954-753-5172
Practice Address - Street 1:10161 W SAMPLE RD
Practice Address - Street 2:STE B
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-3954
Practice Address - Country:US
Practice Address - Phone:954-755-6400
Practice Address - Fax:954-753-5172
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 54935207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E31293Medicare UPIN
FL08875Medicare ID - Type Unspecified