=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821152372
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHANDRA SRINIVAS DACHEPALLI AUD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/20/2006
-----------------------------------------------------
Last Update Date | 01/07/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7530 WOODWARD AVE
-----------------------------------------------------
City | WOODRIDGE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60517-3100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-985-4884
-----------------------------------------------------
Fax | 630-225-5103
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2309 PROVIDENCE CT
-----------------------------------------------------
City | NAPERVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60565-3124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-267-1869
-----------------------------------------------------
Fax | 630-225-5103
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 147001152
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------