Provider Demographics
NPI:1174564124
Name:CHANDIRAMANI, SHANKER (MD)
Entity type:Individual
Prefix:
First Name:SHANKER
Middle Name:
Last Name:CHANDIRAMANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 950248
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0248
Mailing Address - Country:US
Mailing Address - Phone:502-253-1035
Mailing Address - Fax:502-253-1037
Practice Address - Street 1:3793 POPLAR LEVEL RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-1044
Practice Address - Country:US
Practice Address - Phone:502-897-7107
Practice Address - Fax:502-897-7613
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY27012207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000057119QOtherHUMANA-NBHS
KY125263OtherSIHO -NBHS
KYP00933110OtherMEDICARE RAILROAD KY - NBHS
KY000000709130OtherANTHEM-NBHS
KY64270127Medicaid
KY0355747OtherCIGNA-NBHS
KY50032634OtherPASSPORT-NBHS
KYP00933110OtherMEDICARE RAILROAD KY - NBHS
E10499Medicare UPIN
KYK002670Medicare PIN