Provider Demographics
NPI:1609980549
Name:ESARIYA-UMPAI, KANCHANA (MD)
Entity Type:Individual
Prefix:DR
First Name:KANCHANA
Middle Name:
Last Name:ESARIYA-UMPAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KANCHANA
Other - Middle Name:
Other - Last Name:UMPAI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1026 ESSINGTON RD
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-2841
Mailing Address - Country:US
Mailing Address - Phone:815-744-2556
Mailing Address - Fax:815-744-3554
Practice Address - Street 1:1026 ESSINGTON RD
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-2841
Practice Address - Country:US
Practice Address - Phone:815-744-2556
Practice Address - Fax:815-744-3554
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036060991174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD93820Medicare UPIN