MEDICARE: DR. ANUP K 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	207N00000X	Dermatology Physician	036094335	IL
2	207NS0135X	Procedural Dermatology Physician	036094335	IL
3	207R00000X	Internal Medicine Physician	036094335	IL

General Provider Information

NPI Number	:	1700843570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANUP K CHAUDHRY M.D.

Provider Business Mailing Address
First Line	:	1175 CEDAR CT
Second Line	:
City	:	CARBONDALE
State	:	IL
Zip	:	62901-5333
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	:

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

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	10/24/2012

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