Provider Demographics
NPI:1811969066
Name:PIRYANI, CHANDUR (MD)
Entity type:Individual
Prefix:
First Name:CHANDUR
Middle Name:
Last Name:PIRYANI
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 1:1601 ROOSEVELT RD
Mailing Address - Street 2:PO BOX 6
Mailing Address - City:NIAGARA
Mailing Address - State:WI
Mailing Address - Zip Code:54151-1043
Mailing Address - Country:US
Mailing Address - Phone:888-724-6377
Mailing Address - Fax:888-214-9699
Practice Address - Street 1:1601 ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:NIAGARA
Practice Address - State:WI
Practice Address - Zip Code:54151-1043
Practice Address - Country:US
Practice Address - Phone:888-724-6377
Practice Address - Fax:888-214-9699
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI41270208VP0014X
MI4301075144208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI050076128OtherRAILROAD MEDICARE
MI050B210120OtherBCBS
MI4162339Medicaid
1024529OtherPREFERRED ONE
WI050076130OtherRAILROAD MEDICARE
WI32526700Medicaid
MIOM24440-005Medicare ID - Type Unspecified
WI40015-0006Medicare ID - Type Unspecified
WI050076130OtherRAILROAD MEDICARE
WI32526700Medicaid