Provider Demographics
NPI:1700843570
Name:CHAUDHRY, ANUP K (MD)
Entity Type:Individual
Prefix:DR
First Name:ANUP
Middle Name:K
Last Name:CHAUDHRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ANUP
Other - Middle Name:K
Other - Last Name:CHAUDHRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1175 CEDAR CT
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-5333
Mailing Address - Country:US
Mailing Address - Phone:618-549-0300
Mailing Address - Fax:
Practice Address - Street 1:1175 CEDAR CT
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-5333
Practice Address - Country:US
Practice Address - Phone:618-549-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036094335207N00000X, 207NS0135X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC43899Medicare UPIN