Healthcare Provider Details

I. General information

NPI: 1346505286
Provider Name (Legal Business Name): SNEHA ABICHANDANI M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: FNU SNEHA M.D

II. Dates (important events)

Enumeration Date: 07/06/2012
Last Update Date: 12/23/2019
Certification Date: 12/23/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5843 SOUTH WESTERN
CHICAGO IL
60636
US

IV. Provider business mailing address

800 EAST 55TH STREET
CHICAGO IL
60615
US

V. Phone/Fax

Practice location:
  • Phone: 773-434-8600
  • Fax:
Mailing address:
  • Phone: 773-702-0660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301100446
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036145878
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036.145878
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: