Healthcare Provider Details

I. General information

NPI: 1598394306
Provider Name (Legal Business Name): ARCHANA CHANDRASHEKAR D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2020
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 W 95TH ST STE 408
OAK LAWN IL
60453-2662
US

IV. Provider business mailing address

15855 19 MILE RD
CLINTON TOWNSHIP MI
48038-3504
US

V. Phone/Fax

Practice location:
  • Phone: 708-346-4055
  • Fax: 708-499-0948
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number5151014382
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number03676494
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: