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General NPI Number Information
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NPI Number | 1821034224
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Entity Type | Organization
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Legal Business Name | DATTA SAMBARE M D S C
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 06/03/2009
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Provider Practice Location Address
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Address Line | 5650 W MADISON ST
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City | CHICAGO
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State | IL
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Zip | 60644-3939
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Country | US
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Telephone | 773-379-2304
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 215
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City | WESTMONT
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State | IL
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Zip | 60559-0215
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DATTA SAMBARE
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Credential | M.D.
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Telephone | 773-379-2304
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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