Provider Demographics
NPI:1649507328
Name:CHOUDHARY, VIKRAM (CPO)
Entity type:Individual
Prefix:
First Name:VIKRAM
Middle Name:
Last Name:CHOUDHARY
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 N MCCLURG CT APT 113
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4352
Mailing Address - Country:US
Mailing Address - Phone:219-793-3339
Mailing Address - Fax:312-300-4473
Practice Address - Street 1:440 N MCCLURG CT APT 113
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4352
Practice Address - Country:US
Practice Address - Phone:219-793-3339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-17
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL211.000222224P00000X
IL213.000389222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist