=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366539264
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ASHA CHHABLANI M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2800 SOUTH VERNON AVENUE 2ND FLOOR
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60616-2907
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-791-2681
-----------------------------------------------------
Fax | 312-791-2691
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2800 SOUTH ELLIS AVENUE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60616-2907
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-791-2681
-----------------------------------------------------
Fax | 312-791-2691
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------