1790972990 NPI number — CHANDRA DIAGNOSTIC CARDIOLOGY 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 1790972990 NPI number — CHANDRA DIAGNOSTIC CARDIOLOGY LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHANDRA DIAGNOSTIC CARDIOLOGY 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:
1790972990
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/25/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4250 N MARINE DR
Provider Second Line Business Mailing Address:
SUITE 236
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60613-1744
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-404-0160
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 INGALLS DR
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:
60426-3558
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-333-2300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CHANDRA
Authorized Official First Name:
LOKESH
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN OWNER
Authorized Official Telephone Number:
773-731-5456

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  036092076 , 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: 1632281 . This is a "BCBSIL GROUP #" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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