Healthcare Provider Details

I. General information

NPI: 1932891728
Provider Name (Legal Business Name): RAVNOOR KAUR CHANDI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 05/22/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1431 N WESTERN AVE STE 406
CHICAGO IL
60622-1774
US

IV. Provider business mailing address

1431 N WESTERN AVE STE 406
CHICAGO IL
60622-1774
US

V. Phone/Fax

Practice location:
  • Phone: 312-633-5841
  • Fax: 312-491-5020
Mailing address:
  • Phone: 312-633-5841
  • Fax: 312-491-5020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: