Provider Demographics
NPI:1073978243
Name:CHANDA MENDI MDSC
Entity Type:Organization
Organization Name:CHANDA MENDI MDSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHERISE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-840-2297
Mailing Address - Street 1:7257 S JEFFERY BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649-3014
Mailing Address - Country:US
Mailing Address - Phone:773-684-0002
Mailing Address - Fax:
Practice Address - Street 1:7257 S JEFFERY BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-3014
Practice Address - Country:US
Practice Address - Phone:773-684-0002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036047008207Q00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty