Individual
DR. CHARUKESI CHANDRASEKARAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4450 HIGHLAND AVE, BEAUMONT, TX 77705-5205
(713) 351-7360
Mailing address
PO BOX 66308, HOUSTON, TX 77266-6308
(832) 548-5000
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
Q2263
TX
2084P0804X
Child & Adolescent Psychiatry Physician
Q2263
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080462703
LEGACY COMMUNITY HEALTH SERVICES INC MEDICIAID
TX
01
—
7471809
LEGACY SITE SPECIFIC MEDICARE #
TX
Enumeration date
09/02/2010
Last updated
09/14/2015
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