Provider Demographics
NPI:1932118726
Name:KADAKIA, CHAITANYA S (MD)
Entity Type:Individual
Prefix:
First Name:CHAITANYA
Middle Name:S
Last Name:KADAKIA
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 1:7111 N MAIN ST
Mailing Address - Street 2:SUITE 10
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-2565
Mailing Address - Country:US
Mailing Address - Phone:937-277-2121
Mailing Address - Fax:937-277-2213
Practice Address - Street 1:7111 N MAIN ST
Practice Address - Street 2:SUITE 10
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-2565
Practice Address - Country:US
Practice Address - Phone:937-277-2121
Practice Address - Fax:937-277-2213
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.047060207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0639107Medicaid
OH0514725Medicare PIN
OH0514726Medicare PIN