Provider Demographics
NPI:1184801748
Name:CHHABRIA, PESSOOLAL S (MD)
Entity type:Individual
Prefix:
First Name:PESSOOLAL
Middle Name:S
Last Name:CHHABRIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1616 GRAND AVE
Mailing Address - Street 2:103
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-3600
Mailing Address - Country:US
Mailing Address - Phone:847-249-3100
Mailing Address - Fax:847-249-3199
Practice Address - Street 1:1616 GRAND AVE
Practice Address - Street 2:103
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-3600
Practice Address - Country:US
Practice Address - Phone:847-249-3100
Practice Address - Fax:847-249-3199
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-25
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0528492084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-052849Medicaid
IL036-052849Medicaid
IL36-3087718Medicare PIN