Healthcare Provider Details

I. General information

NPI: 1922008069
Provider Name (Legal Business Name): MONIKA CHAUDHARI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 W POLK ST
CHICAGO IL
60612-3723
US

IV. Provider business mailing address

1950 W POLK ST
CHICAGO IL
60612-3723
US

V. Phone/Fax

Practice location:
  • Phone: 312-864-1810
  • Fax:
Mailing address:
  • Phone: 312-864-1810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number036171430
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: