Provider Demographics
NPI:1376710210
Name:CHADHA, SHIVANI (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIVANI
Middle Name:
Last Name:CHADHA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6715 KINGERY HWY
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5142
Mailing Address - Country:US
Mailing Address - Phone:630-537-1125
Mailing Address - Fax:630-861-0929
Practice Address - Street 1:6715 KINGERY HWY
Practice Address - Street 2:
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-5142
Practice Address - Country:US
Practice Address - Phone:630-537-1125
Practice Address - Fax:630-861-0929
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-09
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.012428207L00000X
IL036-128363208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400213363Medicare PIN