Provider Demographics
NPI:1689812554
Name:CHAUHAN, DEEPTI (MD)
Entity Type:Individual
Prefix:
First Name:DEEPTI
Middle Name:
Last Name:CHAUHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:901 MCCLINTOCK DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-0871
Mailing Address - Country:US
Mailing Address - Phone:888-220-6432
Mailing Address - Fax:630-734-4715
Practice Address - Street 1:1100 LAKE ST
Practice Address - Street 2:STE. LL56
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1015
Practice Address - Country:US
Practice Address - Phone:888-220-6432
Practice Address - Fax:630-734-4715
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-30
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036123677207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036123677Medicaid
IL036123677Medicaid