Healthcare Provider Details

I. General information

NPI: 1720240179
Provider Name (Legal Business Name): SARA CHOWDHURY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 WAUKEGAN RD STE 140
BANNOCKBURN IL
60015-1868
US

IV. Provider business mailing address

2151 WAUKEGAN RD STE 140
BANNOCKBURN IL
60015-1868
US

V. Phone/Fax

Practice location:
  • Phone: 847-663-8540
  • Fax: 847-663-1015
Mailing address:
  • Phone: 847-570-2040
  • Fax: 847-733-5315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number036132340
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: