Healthcare Provider Details

I. General information

NPI: 1649349424
Provider Name (Legal Business Name): PK CHANDARANA MD LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15505 127TH STREET
LEMONT IL
60439
US

IV. Provider business mailing address

6458 BIG BEAR DR
INDIAN HEAD PARK IL
60435
US

V. Phone/Fax

Practice location:
  • Phone: 708-313-6878
  • Fax: 708-246-6674
Mailing address:
  • Phone: 708-246-2468
  • Fax: 708-246-6674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number03646440
License Number StateIL

VIII. Authorized Official

Name: PARAGINI KANTILAL CHANDARANA
Title or Position: PRESIDENT PK CHANDARANA MD LTD
Credential: MD
Phone: 708-313-6878