Provider Demographics
NPI:1205800257
Name:CHAND, SUNIL GUPTA (MD)
Entity type:Individual
Prefix:DR
First Name:SUNIL
Middle Name:GUPTA
Last Name:CHAND
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:PO BOX 107
Mailing Address - Street 2:1031 EAST KARSCH BLVD
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-0107
Mailing Address - Country:US
Mailing Address - Phone:573-756-7880
Mailing Address - Fax:
Practice Address - Street 1:1031 E KARSCH BLVD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-3404
Practice Address - Country:US
Practice Address - Phone:573-756-7880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO109266207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208564112Medicaid
MO595444209Medicaid
MO590121307Medicaid
MO505183608Medicaid
110174219OtherRAILROAD MEDICARE
MO268945Medicare PIN
MOG11633Medicare UPIN
110174219OtherRAILROAD MEDICARE