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General NPI Number Information
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NPI Number | 1720347032
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Entity Type | Organization
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Legal Business Name | AMAL K. MUKHERJEE MD SC
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Dates
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Enumeration Date | 05/07/2012
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Last Update Date | 05/07/2012
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Provider Practice Location Address
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Address Line | 840 W IRVING PARK AVE SUITE 301
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City | CHICAGO
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State | IL
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Zip | 68613
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Country | US
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Telephone | 773-525-6064
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Fax | 773-525-6064
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Provider Business Mailing Address
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Address Line | 1409 BURR OAK RD UNIT 102A
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City | HINSDALE
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State | IL
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Zip | 68521
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Country | US
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Telephone | 773-525-6064
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Fax | 773-525-6067
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Authorized Official
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Title or Position | PRESIDENT
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Name | AMAL K MUKHERJEE
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Credential | MD
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Telephone | 773-525-6064
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 036048011
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License Number State | IL
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