Healthcare Provider Details

I. General information

NPI: 1205889706
Provider Name (Legal Business Name): CHITRA SRINIVASAN MADHAVAN M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 09/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1177 N HIGHLAND AVE
AURORA IL
60506-2281
US

IV. Provider business mailing address

4330 PINE LAKE DR
NAPERVILLE IL
60564-9776
US

V. Phone/Fax

Practice location:
  • Phone: 630-892-5500
  • Fax: 630-892-5005
Mailing address:
  • Phone: 630-892-5500
  • Fax: 630-892-5005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number036074401
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number036074401
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: