Provider Demographics
NPI:1700803798
Name:CHAKRABARTY, MILAN S (MD)
Entity Type:Individual
Prefix:DR
First Name:MILAN
Middle Name:S
Last Name:CHAKRABARTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MILANKUMAR
Other - Middle Name:S
Other - Last Name:CHAKRABARTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 5400
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92544-0400
Mailing Address - Country:US
Mailing Address - Phone:951-652-2252
Mailing Address - Fax:951-658-6476
Practice Address - Street 1:1003 E FLORIDA AVE
Practice Address - Street 2:# 101
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4510
Practice Address - Country:US
Practice Address - Phone:951-652-2252
Practice Address - Fax:951-658-6476
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36675207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA39268Medicare UPIN
CA00A366750Medicare PIN