Provider Demographics
NPI:1053412189
Name:MILAN S CHAKRABARTY MD
Entity type:Organization
Organization Name:MILAN S CHAKRABARTY MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MILAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHAKRABARTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-652-2252
Mailing Address - Street 1:PO BOX 5160
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92544-0160
Mailing Address - Country:US
Mailing Address - Phone:951-929-6260
Mailing Address - Fax:951-765-2855
Practice Address - Street 1:1003 E FLORIDA AVE
Practice Address - Street 2:# 104
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4510
Practice Address - Country:US
Practice Address - Phone:951-652-2252
Practice Address - Fax:951-652-3173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ37688ZOtherMEDICARE PTAN