Provider Demographics
NPI:1124009691
Name:CHAWLA, KAMAL K (MD)
Entity Type:Individual
Prefix:DR
First Name:KAMAL
Middle Name:K
Last Name:CHAWLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2800 N SHERIDAN RD
Mailing Address - Street 2:SUITE 510
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-6156
Mailing Address - Country:US
Mailing Address - Phone:773-348-7555
Mailing Address - Fax:773-348-7585
Practice Address - Street 1:2800 N SHERIDAN RD
Practice Address - Street 2:SUITE 510
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6156
Practice Address - Country:US
Practice Address - Phone:773-348-7555
Practice Address - Fax:773-348-7585
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036044920207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036044920Medicaid
IL036044920Medicaid
ILD13275Medicare UPIN