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General NPI Number Information
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NPI Number | 1215267786
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Entity Type | Organization
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Legal Business Name | MEDICAL ASSOCIATES OF CHATAM, LTD
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Dates
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Enumeration Date | 01/06/2010
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Last Update Date | 07/30/2015
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Provider Practice Location Address
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Address Line | 8541 S STATE ST SUITE #9
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City | CHICAGO
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State | IL
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Zip | 60619-5665
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Country | US
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Telephone | 773-488-2595
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Fax | 773-783-8561
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Provider Business Mailing Address
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Address Line | 8541 S STATE ST SUITE #9
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City | CHICAGO
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State | IL
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Zip | 60619-5665
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Country | US
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Telephone | 773-488-2595
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Fax | 773-783-8561
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | VIJAYA K SARMA
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Credential | M.D.
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Telephone | 773-488-2595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 036099712
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License Number State | IL
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