Provider Demographics
NPI:1710061650
Name:CHANDAN, RITU (DO)
Entity Type:Individual
Prefix:
First Name:RITU
Middle Name:
Last Name:CHANDAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 RIVERSIDE DR STE 2800
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-5004
Mailing Address - Country:US
Mailing Address - Phone:815-935-1100
Mailing Address - Fax:815-937-5966
Practice Address - Street 1:400 RIVERSIDE DR STE 2800
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914
Practice Address - Country:US
Practice Address - Phone:815-935-1100
Practice Address - Fax:815-937-5966
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036098184207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036098184Medicaid
ILK24638Medicare ID - Type Unspecified