Provider Demographics
NPI:1740563311
Name:CHIKANI, AMIT
Entity Type:Individual
Prefix:
First Name:AMIT
Middle Name:
Last Name:CHIKANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9328 SAYRE AVE
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-1228
Mailing Address - Country:US
Mailing Address - Phone:847-581-0132
Mailing Address - Fax:
Practice Address - Street 1:1606 N MOBILE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639-3814
Practice Address - Country:US
Practice Address - Phone:773-836-9691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.291268183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist