Provider Demographics
NPI:1730269150
Name:BASU, CHANDRASEKHAR BOB (MD)
Entity type:Individual
Prefix:DR
First Name:CHANDRASEKHAR
Middle Name:BOB
Last Name:BASU
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 1:9899 TOWNE LAKE PARKWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433
Mailing Address - Country:US
Mailing Address - Phone:713-799-2278
Mailing Address - Fax:713-333-2774
Practice Address - Street 1:9899 TOWNE LAKE PARKWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433
Practice Address - Country:US
Practice Address - Phone:713-799-2278
Practice Address - Fax:713-333-2774
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM14982086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176182702Medicaid
I42111Medicare UPIN
TX176182702Medicaid