Provider Demographics
NPI:1821092750
Name:CHANDRASHEKAR, NAGASHREE (MD)
Entity Type:Individual
Prefix:
First Name:NAGASHREE
Middle Name:
Last Name:CHANDRASHEKAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NAGASHREE
Other - Middle Name:
Other - Last Name:HANUMANTHATAYAPPA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:15990 W 9 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4826
Mailing Address - Country:US
Mailing Address - Phone:248-849-4226
Mailing Address - Fax:248-849-4240
Practice Address - Street 1:21700 NORTHWESTERN HWY
Practice Address - Street 2:STE 600
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4912
Practice Address - Country:US
Practice Address - Phone:248-559-6664
Practice Address - Fax:248-553-5628
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301074409207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI456437110Medicaid
MI0F36477105Medicare ID - Type Unspecified
MI456437110Medicaid