Basic Information
Provider Information
NPI: 1720034796
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BATRA
FirstName: CHANDRAMOHAN
MiddleName: P
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9943 HICKMAN RD
Address2: SUITE 105
City: URBANDALE
State: IA
PostalCode: 503225304
CountryCode: US
TelephoneNumber: 5152481447
FaxNumber: 5152481440
Practice Location
Address1: 250 LAUREL ST
Address2:  
City: DES MOINES
State: IA
PostalCode: 503143024
CountryCode: US
TelephoneNumber: 5156434610
FaxNumber: 5156434662
Other Information
ProviderEnumerationDate: 05/25/2006
LastUpdateDate: 11/26/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000X35153IAN Allopathic & Osteopathic PhysiciansEmergency Medicine 
207Q00000X35153IAY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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