Provider Demographics
NPI:1265874838
Name:CHANDRASEKARAN, VINODKUMAR (MD)
Entity type:Individual
Prefix:DR
First Name:VINODKUMAR
Middle Name:
Last Name:CHANDRASEKARAN
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 1:303 W GREEN ST
Mailing Address - Street 2:APT NO. F103
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-8000
Mailing Address - Country:US
Mailing Address - Phone:217-377-1364
Mailing Address - Fax:
Practice Address - Street 1:611 WEST PARK ST
Practice Address - Street 2:CARLE HOSPITAL,
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801
Practice Address - Country:US
Practice Address - Phone:217-383-3110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125062896207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine