Healthcare Provider Details

I. General information

NPI: 1447530639
Provider Name (Legal Business Name): NALINI AHLUWALIA, MD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2011
Last Update Date: 08/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 W DEVON AVE
CHICAGO IL
60660-1314
US

IV. Provider business mailing address

6440 HILLCREST DR
BURR RIDGE IL
60527-5761
US

V. Phone/Fax

Practice location:
  • Phone: 773-465-7888
  • Fax:
Mailing address:
  • Phone: 630-698-0237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036.063909
License Number StateIL

VIII. Authorized Official

Name: NALINI AHLUWALIA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 773-465-7888