Provider Demographics
NPI:1821215435
Name:MOHAN, CHANDRAMANI (MD)
Entity Type:Individual
Prefix:DR
First Name:CHANDRAMANI
Middle Name:
Last Name:MOHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 WOODVIEW CT
Mailing Address - Street 2:BLDG 32, APT#378
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-4184
Mailing Address - Country:US
Mailing Address - Phone:248-844-8013
Mailing Address - Fax:
Practice Address - Street 1:PROVIDENCE HOSPITAL
Practice Address - Street 2:16001, WEST NINE MILE ROAD
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075
Practice Address - Country:US
Practice Address - Phone:248-849-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301088844208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery