Healthcare Provider Details

I. General information

NPI: 1790705663
Provider Name (Legal Business Name): SANGILI CHANDRAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9555 S. 52ND AVE.
OAK LAWN IL
60453
US

IV. Provider business mailing address

9555 S. 52ND AVE.
OAK LAWN IL
60453
US

V. Phone/Fax

Practice location:
  • Phone: 708-634-0950
  • Fax:
Mailing address:
  • Phone: 708-634-0950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number036087174
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036-087174
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: