Healthcare Provider Details

I. General information

NPI: 1356316541
Provider Name (Legal Business Name): VINEETA CHANDRA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 09/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2905 NORTH MAIN ST COMMUNITY HEALTH IMPROVEMENT CENTER
DECATUR IL
62526
US

IV. Provider business mailing address

2905 NORTH MAIN ST
DECATUR IL
62526
US

V. Phone/Fax

Practice location:
  • Phone: 217-877-9117
  • Fax: 217-877-3077
Mailing address:
  • Phone: 217-877-9117
  • Fax: 217-877-3077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036111224
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: