Basic Information
| Provider Information | |||||||||
| NPI: | 1437188620 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MADHUKAR CHHATRE MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3151 NE CARNEGIE DR | ||||||||
| Address2: | |||||||||
| City: | LEES SUMMIT | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640643215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164618288 | ||||||||
| FaxNumber: | 8164616586 | ||||||||
| Practice Location | |||||||||
| Address1: | 3151 NE CARNEGIE DR | ||||||||
| Address2: | |||||||||
| City: | LEES SUMMIT | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640643215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8163470026 | ||||||||
| FaxNumber: | 8164616586 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2006 | ||||||||
| LastUpdateDate: | 07/11/2013 | ||||||||
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| AuthorizedOfficialLastName: | CHHATRE | ||||||||
| AuthorizedOfficialFirstName: | MADHUKAR | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | MD/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5163735155 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208200000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Plastic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 206747917 | 05 | MO | MEDICAID | 100147510B | 05 | KS | MEDICAID |