Provider Demographics
NPI:1508850439
Name:AHLOWALIA, NEERJA (MD)
Entity Type:Individual
Prefix:
First Name:NEERJA
Middle Name:
Last Name:AHLOWALIA
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 1:7906 S CRANDON AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-1146
Mailing Address - Country:US
Mailing Address - Phone:773-933-0800
Mailing Address - Fax:773-933-5425
Practice Address - Street 1:7906 S CRANDON AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-1146
Practice Address - Country:US
Practice Address - Phone:773-933-0800
Practice Address - Fax:773-933-5425
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036064624207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036064624Medicaid
IL036064624Medicaid
405150Medicare ID - Type Unspecified