Healthcare Provider Details

I. General information

NPI: 1174263404
Provider Name (Legal Business Name): SNEHA CHEBROLU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2022
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W HARRISON ST STE 1159
CHICAGO IL
60612-3883
US

IV. Provider business mailing address

MEDICAL CENTER BLVD
WINSTON SALEM NC
27157-0001
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-5020
  • Fax:
Mailing address:
  • Phone: 336-716-3182
  • Fax: 336-713-9619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036.180030
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036.180030
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: