MEDICARE: DR. ALPA CHANDARANA 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	2085R0202X	Diagnostic Radiology Physician	036101919	IL
2	2085R0204X	Vascular & Interventional Radiology Physician	36101919	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	:	1710964689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALPA CHANDARANA MD

Provider Business Mailing Address
First Line	:	680 N LAKE SHORE DR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-4546
Country	:	US
Telephone Number	:
Fax Number	:	312-695-5645

Provider Business Practice Location Address
First Line	:	250 E SUPERIOR ST
Second Line	:	RM. 4-2304
City	:	CHICAGO
State	:	IL
Zip	:	60611-2914
Country	:	US
Telephone Number	:	312-472-0436
Fax Number	:	312-472-0480

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

Provider Enumeration Date	:	12/30/2005
Last Update Date	:	05/09/2013

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