1649349424 NPI number — PK CHANDARANA MD LTD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649349424 NPI number — PK CHANDARANA MD LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PK CHANDARANA MD LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649349424
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6458 BIG BEAR DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIAN HEAD PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60435
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-246-2468
Provider Business Mailing Address Fax Number:
708-246-6674

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15505 127TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEMONT
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60439
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-313-6878
Provider Business Practice Location Address Fax Number:
708-246-6674
Provider Enumeration Date:
11/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHANDARANA
Authorized Official First Name:
PARAGINI
Authorized Official Middle Name:
KANTILAL
Authorized Official Title or Position:
PRESIDENT PK CHANDARANA MD LTD
Authorized Official Telephone Number:
708-313-6878

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  03646440 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 03646440 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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