Healthcare Provider Details

I. General information

NPI: 1750934584
Provider Name (Legal Business Name): SOLAB CHITRAKAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2019
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 ROXBURY RD
ROCKFORD IL
61107-5089
US

IV. Provider business mailing address

44 WASHINGTON ST APT 704
BROOKLINE MA
02445-7105
US

V. Phone/Fax

Practice location:
  • Phone: 815-227-8331
  • Fax:
Mailing address:
  • Phone: 872-806-3032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number036.159910
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number125074087
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number3013503
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036.159910
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: