Provider Demographics
NPI:1013934710
Name:CHANDRASHEKAR, LINGAIAH (MD)
Entity Type:Individual
Prefix:
First Name:LINGAIAH
Middle Name:
Last Name:CHANDRASHEKAR
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 1:2200 JEFFERSON AVE FL 5
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-7102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:225 MEDICAL CENTER DR STE 308
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003
Practice Address - Country:US
Practice Address - Phone:270-443-0777
Practice Address - Fax:270-443-0999
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD39482207RG0100X
IN01058085A207RG0100X
KY52067207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3330719Medicaid
H93190Medicare UPIN
TN3330719Medicaid