=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922008069
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MONIKA CHAUDHARI MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2005
-----------------------------------------------------
Last Update Date | 10/11/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1950 W POLK ST
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60612-3723
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-864-1810
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1950 W POLK ST
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60612-3723
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-864-1810
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2080P0205X
-----------------------------------------------------
Taxonomy Name | Pediatric Endocrinology Physician
-----------------------------------------------------
License Number | 036171430
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------