Provider Demographics
NPI:1790725307
Name:DAVE, CHIRAG (MD)
Entity Type:Individual
Prefix:
First Name:CHIRAG
Middle Name:
Last Name:DAVE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 CROSSROADS PL
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-6545
Mailing Address - Country:US
Mailing Address - Phone:618-241-8791
Mailing Address - Fax:618-241-8623
Practice Address - Street 1:209 CROSSROADS PL
Practice Address - Street 2:SUITE 110
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-6545
Practice Address - Country:US
Practice Address - Phone:618-241-8791
Practice Address - Fax:618-241-8623
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-103078207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL371334126286402Medicaid
SC280207Medicaid
NC5901672Medicaid
SC280207Medicaid
IL599560Medicare PIN
NC5901672Medicaid