Individual
DR. BISHAN CHAKRAVARTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
703 MAPLE VALLEY DRIVE, FARMINGTON, MO 63640
(573) 701-0470
(573) 701-0473
Mailing address
703 MAPLE VALLEY DRIVE, FARMINGTON, MO 63640
(573) 701-0470
(573) 701-0473
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2018009371
MO
207RN0300X
Nephrology Physician
Primary
2018009371
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200052190
—
MO
Enumeration date
07/21/2012
Last updated
08/23/2018
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