Provider Demographics
NPI:1528408796
Name:CHANA, ANJU (MD)
Entity Type:Individual
Prefix:MRS
First Name:ANJU
Middle Name:
Last Name:CHANA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANJU
Other - Middle Name:
Other - Last Name:BHOGAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 WEST RIVER DRIVE
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52801-1014
Mailing Address - Country:US
Mailing Address - Phone:563-336-3000
Mailing Address - Fax:563-336-3125
Practice Address - Street 1:500 WEST RIVER DRIVE
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52801-1014
Practice Address - Country:US
Practice Address - Phone:563-336-3000
Practice Address - Fax:563-336-3000
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2017-06-30
Deactivation Date:2014-04-03
Deactivation Code:
Reactivation Date:2014-05-06
Provider Licenses
StateLicense IDTaxonomies
IA43347207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine