MEDICARE: MADHUMITA CHATTERJEE MD

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	01081107B	IN
2	207Q00000X	Family Medicine Physician	036092056	IL
3	207P00000X	Emergency Medicine Physician	036092056	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	F400191295	OTHER	IL	MEDICARE PTAN

General Provider Information

NPI Number	:	1679510804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADHUMITA CHATTERJEE MD

Provider Business Mailing Address
First Line	:	611 W. PARK ST
Second Line	:	FAPC
City	:	URBANA
State	:	IL
Zip	:	61801
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3024 E EMPIRE ST STE 3A
Second Line	:
City	:	BLOOMINGTON
State	:	IL
Zip	:	61704-5402
Country	:	US
Telephone Number	:	309-556-7700
Fax Number	:

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

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	08/19/2025

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