Provider Demographics
NPI:1710997259
Name:MUKHERJEE, ASHISH (MD, FACC)
Entity Type:Individual
Prefix:
First Name:ASHISH
Middle Name:
Last Name:MUKHERJEE
Suffix:
Gender:M
Credentials:MD, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 S ARCHER AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60632-3663
Mailing Address - Country:US
Mailing Address - Phone:773-767-8375
Mailing Address - Fax:773-767-8532
Practice Address - Street 1:4900 S ARCHER AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60632-3663
Practice Address - Country:US
Practice Address - Phone:773-767-8375
Practice Address - Fax:773-767-8532
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036063329207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036063329Medicaid
IL036063329Medicaid
IL907490Medicare ID - Type Unspecified