Healthcare Provider Details

I. General information

NPI: 1477496594
Provider Name (Legal Business Name): LALITA REGINA CHEAHTAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7731 S HALSTED ST
CHICAGO IL
60620-2412
US

IV. Provider business mailing address

7731 S HALSTED ST
CHICAGO IL
60620-2412
US

V. Phone/Fax

Practice location:
  • Phone: 773-962-3701
  • Fax: 312-569-7031
Mailing address:
  • Phone: 773-962-3701
  • Fax: 312-569-7031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041278848
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: