Provider Demographics
NPI:1649362567
Name:JOHN, CHANDY C (MD)
Entity type:Individual
Prefix:
First Name:CHANDY
Middle Name:C
Last Name:JOHN
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 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1044 W WALNUT ST
Practice Address - Street 2:R4 402D
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5254
Practice Address - Country:US
Practice Address - Phone:317-274-8940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010755512080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201308880Medicaid
IN145590097Medicare PIN
1044948OtherPREFERRED ONE
F48181Medicare UPIN
92-00196OtherMEDICA-CHOICE
B657OtherCHAMPUS
MN989473000Medicaid
2386130OtherARAZ
86245-8OtherFV CAREGIVER
92-12094OtherMEDICA-PRIMARY
440000240Medicare ID - Type Unspecified
MN426M2JOOtherBCBS
HP55784OtherHEALTH PARTNERS
IA0596395Medicare ID - Type UnspecifiedIOWA MEDICAID
WI34703700Medicaid