Healthcare Provider Details

I. General information

NPI: 1396184214
Provider Name (Legal Business Name): AJIT N CHARY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 EASTLAND DR STE 320
BLOOMINGTON IL
61701-7912
US

IV. Provider business mailing address

1505 EASTLAND DR STE 320
BLOOMINGTON IL
61701-7912
US

V. Phone/Fax

Practice location:
  • Phone: 309-661-2368
  • Fax: 309-662-9709
Mailing address:
  • Phone: 309-661-2368
  • Fax: 309-662-9709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number036162266
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number036162266
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036162266
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: