Provider Demographics
NPI:1619080850
Name:CHAUDHARY, MOHAMMAD Y (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:Y
Last Name:CHAUDHARY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3435 W VAN BUREN ST
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60624
Mailing Address - Country:US
Mailing Address - Phone:773-265-0300
Mailing Address - Fax:773-265-8467
Practice Address - Street 1:3435 W VAN BUREN ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60624
Practice Address - Country:US
Practice Address - Phone:773-265-0300
Practice Address - Fax:773-265-8467
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036050545208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036050545Medicaid
IL036050545Medicaid
ILC45141Medicare UPIN