MEDICARE: ASHA CHHABLANI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0001616079	OTHER	IL	BLUE CROSS

General Provider Information

NPI Number	:	1366539264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHA CHHABLANI M.D.

Provider Business Mailing Address
First Line	:	2800 SOUTH ELLIS AVENUE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-2907
Country	:	US
Telephone Number	:	312-791-2681
Fax Number	:	312-791-2691

Provider Business Practice Location Address
First Line	:	2800 SOUTH VERNON AVENUE
Second Line	:	2ND FLOOR
City	:	CHICAGO
State	:	IL
Zip	:	60616-2907
Country	:	US
Telephone Number	:	312-791-2681
Fax Number	:	312-791-2691

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	07/08/2007

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