1356441489 NPI number — MILAN S. CHAKRABARTY M.D. INC

Table of content: (NPI 1356441489)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356441489 NPI number — MILAN S. CHAKRABARTY M.D. INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MILAN S. CHAKRABARTY M.D. INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356441489
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/09/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HEMET
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92544-0400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-929-6260
Provider Business Mailing Address Fax Number:
951-765-2855

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1003 E FLORIDA AVE
Provider Second Line Business Practice Location Address:
# 101
Provider Business Practice Location Address City Name:
HEMET
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92543-4510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-652-2252
Provider Business Practice Location Address Fax Number:
951-652-3173
Provider Enumeration Date:
09/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHAKRABARTY
Authorized Official First Name:
MILAN
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
951-652-2252

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  A36675 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: GR0060110 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com