Provider Demographics
NPI:1205889706
Name:MADHAVAN, CHITRA SRINIVASAN (MD)
Entity type:Individual
Prefix:DR
First Name:CHITRA
Middle Name:SRINIVASAN
Last Name:MADHAVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4330 PINE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-9776
Mailing Address - Country:US
Mailing Address - Phone:630-892-5500
Mailing Address - Fax:630-892-5005
Practice Address - Street 1:1177 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-2281
Practice Address - Country:US
Practice Address - Phone:630-892-5500
Practice Address - Fax:630-892-5005
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036074401207RH0003X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC49809Medicare UPIN