MEDICARE: MUKESH CHAUDHRY 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	207Q00000X	Family Medicine Physician	036-107111	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508866559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MUKESH CHAUDHRY M.D.

Provider Business Mailing Address
First Line	:	190 HIGH FOREST DR
Second Line	:
City	:	CARBONDALE
State	:	IL
Zip	:	62903-8245
Country	:	US
Telephone Number	:	618-549-0300
Fax Number	:

Provider Business Practice Location Address
First Line	:	1175 CEDAR CT
Second Line	:
City	:	CARBONDALE
State	:	IL
Zip	:	62901-5333
Country	:	US
Telephone Number	:	618-549-0300
Fax Number	:	618-549-0600

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

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	01/11/2011

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