Individual provider · NPI-1

Dr. Bishan Chakravarty, M.D.

Internal Medicine, Nephrology · Farmington, MO

NPI number1790030195
StatusActive
Last updated in NPPESAug 23, 2018

Details

NPI
1790030195
Entity type
Individual (NPI-1)
Name
Dr. Bishan Chakravarty
Credential
M.D.
Sex
Male
Sole proprietor
No
Enumeration date
Jul 21, 2012
Last updated
Aug 23, 2018

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207RN0300X Internal Medicine, Nephrology2018009371MOYes
207R00000X Internal Medicine2018009371MO

Practice location

703 Maple Valley Drive
Farmington, MO 63640

Phone 573-701-0470 · Fax 573-701-0473

Mailing address

703 Maple Valley Drive
Farmington, MO 63640

Phone 573-701-0470 · Fax 573-701-0473

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