Provider Demographics
NPI:1972878346
Name:KUTTY K CHANDRAN, MD, PA.
Entity type:Organization
Organization Name:KUTTY K CHANDRAN, MD, PA.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KUTTY
Authorized Official - Middle Name:K
Authorized Official - Last Name:CHANDRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-755-6400
Mailing Address - Street 1:10161 W SAMPLE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-3954
Mailing Address - Country:US
Mailing Address - Phone:954-755-6400
Mailing Address - Fax:954-753-5172
Practice Address - Street 1:10161 W SAMPLE RD
Practice Address - Street 2:SUITE B
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-3954
Practice Address - Country:US
Practice Address - Phone:954-755-6400
Practice Address - Fax:954-753-5172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-18
Last Update Date:2012-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54935261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL061137900Medicaid
FL061137900Medicaid
E31293Medicare UPIN