Provider Demographics
NPI:1013925866
Name:CHANDRA, MAHESH DUTT (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHESH
Middle Name:DUTT
Last Name:CHANDRA
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 1:4911 S ARROWHEAD DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-7005
Mailing Address - Country:US
Mailing Address - Phone:816-795-9595
Mailing Address - Fax:816-795-1188
Practice Address - Street 1:4911 S ARROWHEAD DR
Practice Address - Street 2:SUITE 200
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-7005
Practice Address - Country:US
Practice Address - Phone:816-795-9595
Practice Address - Fax:816-795-1188
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO33977207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1013925866Medicaid
MO205168511Medicaid
MO04888077OtherBLUE CROSS BLUE SHIELD
KS200579980 AMedicaid
MOP0062334Medicare PIN
MO205168511Medicaid
MO1013925866Medicaid
MO04888077OtherBLUE CROSS BLUE SHIELD