Provider Demographics
NPI:1457349979
Name:CHAWLA, PRASHANT K (MD)
Entity Type:Individual
Prefix:DR
First Name:PRASHANT
Middle Name:K
Last Name:CHAWLA
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 1:30 W ERIE ST
Mailing Address - Street 2:#701
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-2827
Mailing Address - Country:US
Mailing Address - Phone:312-755-1595
Mailing Address - Fax:
Practice Address - Street 1:30 W ERIE ST
Practice Address - Street 2:#701
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-2827
Practice Address - Country:US
Practice Address - Phone:312-755-1595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010868492085N0700X
IL0361149202085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology