Healthcare Provider Details

I. General information

NPI: 1992494348
Provider Name (Legal Business Name): BRAJESH KUMAR CHAUDHARY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2023
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 W TAYLOR ST
CHICAGO IL
60612-7232
US

IV. Provider business mailing address

1740 W TAYLOR ST
CHICAGO IL
60612-7232
US

V. Phone/Fax

Practice location:
  • Phone: 212-939-1496
  • Fax:
Mailing address:
  • Phone: 212-939-1406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number125.088915
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: