Provider Demographics
NPI:1700033685
Name:CHUTKAY, INDRANI SHREEKANTH (MD)
Entity Type:Individual
Prefix:DR
First Name:INDRANI
Middle Name:SHREEKANTH
Last Name:CHUTKAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:INDRANI
Other - Middle Name:SHYAMKANT
Other - Last Name:BHASALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2231 TIMBER TRL
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-9036
Mailing Address - Country:US
Mailing Address - Phone:937-599-3115
Mailing Address - Fax:
Practice Address - Street 1:2231 TIMBER TRL
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-9036
Practice Address - Country:US
Practice Address - Phone:937-599-3115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-22
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.090847207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0075001Medicaid
OH0075001Medicaid