Healthcare Provider Details

I. General information

NPI: 1144091596
Provider Name (Legal Business Name): CHELSEA JARIWALA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHELSEA TENBARGE PA

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3665 N BROADWAY ST
CHICAGO IL
60613-4567
US

IV. Provider business mailing address

3665 N BROADWAY ST
CHICAGO IL
60613-4567
US

V. Phone/Fax

Practice location:
  • Phone: 773-496-4433
  • Fax: 773-496-4430
Mailing address:
  • Phone: 773-496-4433
  • Fax: 773-496-4430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085010378
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number085010378
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: