Provider Demographics
NPI:1639132590
Name:NIRAV P CHUDGAR MDSC
Entity Type:Organization
Organization Name:NIRAV P CHUDGAR MDSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:NIRAV
Authorized Official - Middle Name:PRITAMBHAI
Authorized Official - Last Name:CHUDGAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-832-0244
Mailing Address - Street 1:1600 167TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CALUMET CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60409-5445
Mailing Address - Country:US
Mailing Address - Phone:708-832-0244
Mailing Address - Fax:708-832-1008
Practice Address - Street 1:1600 167TH ST STE 200
Practice Address - Street 2:
Practice Address - City:CALUMET CITY
Practice Address - State:IL
Practice Address - Zip Code:60409-5445
Practice Address - Country:US
Practice Address - Phone:708-832-0244
Practice Address - Fax:708-832-1008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2021-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036096495207R00000X
IN01047212A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036096495Medicaid
576680Medicare ID - Type Unspecified
IL036096495Medicaid