Healthcare Provider Details

I. General information

NPI: 1619080850
Provider Name (Legal Business Name): MOHAMMAD Y CHAUDHARY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 05/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3435 W VAN BUREN ST LOWER LEVEL
CHICAGO IL
60624
US

IV. Provider business mailing address

3435 W VAN BUREN ST LOWER LEVEL
CHICAGO IL
60624
US

V. Phone/Fax

Practice location:
  • Phone: 773-265-0300
  • Fax: 773-265-8467
Mailing address:
  • Phone: 773-265-0300
  • Fax: 773-265-8467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036050545
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: