Provider Demographics
NPI:1871652743
Name:VANAGASEM, CHATRI (MD)
Entity Type:Individual
Prefix:DR
First Name:CHATRI
Middle Name:
Last Name:VANAGASEM
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 1:2315 EAST 93RD STREET
Mailing Address - Street 2:SUITE 213
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617
Mailing Address - Country:US
Mailing Address - Phone:773-221-2443
Mailing Address - Fax:773-221-3342
Practice Address - Street 1:2315 EAST 93RD STREET
Practice Address - Street 2:SUITE 213
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617
Practice Address - Country:US
Practice Address - Phone:773-221-2443
Practice Address - Fax:773-221-3342
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01033915A208600000X
IL208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
C41699Medicare UPIN
IN409940Medicare ID - Type Unspecified
IL466920Medicare ID - Type Unspecified