Provider Demographics
NPI:1063453876
Name:CHANDRA, SANDEEP (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDEEP
Middle Name:
Last Name:CHANDRA
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 1:7903 LOCKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:IL
Mailing Address - Zip Code:60459-2115
Mailing Address - Country:US
Mailing Address - Phone:708-422-9577
Mailing Address - Fax:708-422-8101
Practice Address - Street 1:7903 LOCKWOOD AVE
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459-2115
Practice Address - Country:US
Practice Address - Phone:708-422-9577
Practice Address - Fax:708-422-8101
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG29639Medicare UPIN
IL553930Medicare ID - Type Unspecified