Provider Demographics
NPI:1922237700
Name:MUKHOPADHYAY, CHIRANTAN (MD)
Entity Type:Individual
Prefix:MR
First Name:CHIRANTAN
Middle Name:
Last Name:MUKHOPADHYAY
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 1:2650 RIDGE AVE STE 1223
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1700
Mailing Address - Country:US
Mailing Address - Phone:479-826-7158
Mailing Address - Fax:
Practice Address - Street 1:9650 GROSS POINT RD STE 1900
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-5006
Practice Address - Country:US
Practice Address - Phone:224-251-2020
Practice Address - Fax:224-251-2010
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-48343207W00000X, 207WX0107X
390200000X
WI60876207W00000X
IL036133664207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program