Provider Demographics
NPI:1457694903
Name:CHANDRASENA, CHRISTINE VALERIE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:VALERIE
Last Name:CHANDRASENA
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 1:9725 WOODS DR
Mailing Address - Street 2:UNIT 1806
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-4441
Mailing Address - Country:US
Mailing Address - Phone:909-973-0223
Mailing Address - Fax:
Practice Address - Street 1:7447 W TALCOTT AVE
Practice Address - Street 2:SUITE 467
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3745
Practice Address - Country:US
Practice Address - Phone:773-763-1126
Practice Address - Fax:773-594-8487
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL036140052208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program