Provider Demographics
NPI:1790876803
Name:CHAWLA, RADHIKA N (MD)
Entity Type:Individual
Prefix:DR
First Name:RADHIKA
Middle Name:N
Last Name:CHAWLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:614 MARIAN SQ
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-2571
Mailing Address - Country:US
Mailing Address - Phone:630-810-1341
Mailing Address - Fax:630-810-1011
Practice Address - Street 1:3825 HIGHLAND AVE
Practice Address - Street 2:TOWER 1 SUITE 3G
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1552
Practice Address - Country:US
Practice Address - Phone:630-810-1110
Practice Address - Fax:630-810-1011
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4198273OtherAETNA
IL01617506OtherBLUE CROSS BLUE SHIELD
760350Medicare ID - Type Unspecified
IL4198273OtherAETNA