Provider Demographics
NPI:1043343569
Name:CHHABRA, JOGENDRA SINGH (MD)
Entity Type:Individual
Prefix:
First Name:JOGENDRA
Middle Name:SINGH
Last Name:CHHABRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 CARMIE LN
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-1573
Mailing Address - Country:US
Mailing Address - Phone:618-364-0075
Mailing Address - Fax:877-445-6144
Practice Address - Street 1:110 EAST MAIN STREET
Practice Address - Street 2:NORRIS CITY HEALTH CLINIC
Practice Address - City:NORRIS CITY
Practice Address - State:IL
Practice Address - Zip Code:62869-0464
Practice Address - Country:US
Practice Address - Phone:618-378-3440
Practice Address - Fax:877-445-6144
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36112433208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL148968Medicare Oscar/Certification