Basic Information
| Provider Information | |||||||||
| NPI: | 1992990089 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALA | ||||||||
| FirstName: | CHANDRA | ||||||||
| MiddleName: | KANTH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 MACK AVE | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482012136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3134489006 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 400 MACK AVE STE 2 | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482012136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3134489650 | ||||||||
| FaxNumber: | 3134489979 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2007 | ||||||||
| LastUpdateDate: | 07/28/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301090225 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 4301090225 | MI | N | Allopathic & Osteopathic Physicians | Hospitalist | 207RC0000X | 4301090225 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.