Provider Demographics
NPI:1275231813
Name:CHICAGO ARTHRITIS LLC
Entity Type:Organization
Organization Name:CHICAGO ARTHRITIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SIDDHARTH
Authorized Official - Middle Name:
Authorized Official - Last Name:TAMBAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-348-7171
Mailing Address - Street 1:618 W FULTON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-1144
Mailing Address - Country:US
Mailing Address - Phone:773-348-7171
Mailing Address - Fax:773-348-7414
Practice Address - Street 1:618 W FULTON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-1144
Practice Address - Country:US
Practice Address - Phone:773-348-7171
Practice Address - Fax:773-348-7414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-22
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF1003344031Medicaid