Provider Demographics
NPI:1164601415
Name:CHANDARANA MEDICAL ASSOCIATES S.C.
Entity Type:Organization
Organization Name:CHANDARANA MEDICAL ASSOCIATES S.C.
Other - Org Name:SUBURBAN HOSPITAL RADIOLOGIST
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KANTI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDARANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-286-4220
Mailing Address - Street 1:5601 S COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-4875
Mailing Address - Country:US
Mailing Address - Phone:630-286-4220
Mailing Address - Fax:630-286-4247
Practice Address - Street 1:5601 S COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-4875
Practice Address - Country:US
Practice Address - Phone:630-286-4220
Practice Address - Fax:630-286-4247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00228611OtherRR MEDICARE
IL2215278OtherBLUE SHIELD
IL740210OtherMEDICARE LEGACY NUMBER