Provider Demographics
NPI:1649349424
Name:PK CHANDARANA MD LTD
Entity type:Organization
Organization Name:PK CHANDARANA MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PK CHANDARANA MD LTD
Authorized Official - Prefix:
Authorized Official - First Name:PARAGINI
Authorized Official - Middle Name:KANTILAL
Authorized Official - Last Name:CHANDARANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-313-6878
Mailing Address - Street 1:6458 BIG BEAR DR
Mailing Address - Street 2:
Mailing Address - City:INDIAN HEAD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60435
Mailing Address - Country:US
Mailing Address - Phone:708-246-2468
Mailing Address - Fax:708-246-6674
Practice Address - Street 1:15505 127TH STREET
Practice Address - Street 2:
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439
Practice Address - Country:US
Practice Address - Phone:708-313-6878
Practice Address - Fax:708-246-6674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036464402084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL03646440Medicaid