Basic Information
| Provider Information | |||||||||
| NPI: | 1952306292 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHANDRA PRAKASH | ||||||||
| FirstName: | APARNA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9500 EUCLID AVE | ||||||||
| Address2: | MAIL CODE SO10 | ||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441950001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4405196800 | ||||||||
| FaxNumber: | 4405196908 | ||||||||
| Practice Location | |||||||||
| Address1: | 29800 BAINBRIDGE RD | ||||||||
| Address2: | MAIL CODE SO10 | ||||||||
| City: | SOLON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441392202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4405196800 | ||||||||
| FaxNumber: | 4405196908 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2005 | ||||||||
| LastUpdateDate: | 08/08/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 35-088973 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 42355 | WI | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2719080 | 05 | OH | MEDICAID | 34013900 | 05 | WI | MEDICAID |