1902238850 NPI number — MR. SHANTILAL T CHHADWA

Table of content: MR. SHANTILAL T CHHADWA (NPI 1902238850)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902238850 NPI number — MR. SHANTILAL T CHHADWA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHHADWA
Provider First Name:
SHANTILAL
Provider Middle Name:
T
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

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:
1902238850
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/02/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16140 KINGSPORT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLAND PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60467-5602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-339-5381
Provider Business Mailing Address Fax Number:
708-589-2080

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
31 W 155TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARVEY
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-589-2019
Provider Business Practice Location Address Fax Number:
708-589-2080
Provider Enumeration Date:
08/02/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  051033602 , 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: 051033602 . This is a "REGISTERED PHARMACIST" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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