Provider Demographics
NPI:1710964689
Name:CHANDARANA, ALPA (MD)
Entity Type:Individual
Prefix:DR
First Name:ALPA
Middle Name:
Last Name:CHANDARANA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 N LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4546
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:312-695-5645
Practice Address - Street 1:250 E SUPERIOR ST
Practice Address - Street 2:RM. 4-2304
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2914
Practice Address - Country:US
Practice Address - Phone:312-472-0436
Practice Address - Fax:312-472-0480
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361019192085R0202X
IL361019192085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36101919Medicaid
H46428Medicare UPIN
IL203157Medicare ID - Type Unspecified
ILL98575Medicare ID - Type Unspecified