Basic Information
| Provider Information | |||||||||
| NPI: | 1407101165 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHANDRABALAN | ||||||||
| FirstName: | AMEE | ||||||||
| MiddleName: | NATVAR | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SONI | ||||||||
| OtherFirstName: | AMEE | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | D.O. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2828 CHICAGO AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554071320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6128791000 | ||||||||
| FaxNumber: | 6128799116 | ||||||||
| Practice Location | |||||||||
| Address1: | 2828 CHICAGO AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554071320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6128791000 | ||||||||
| FaxNumber: | 6128799116 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2012 | ||||||||
| LastUpdateDate: | 05/25/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 59871 | MN | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.