Provider Demographics
NPI:1649688409
Name:CHICAGOLAND INTEGRATED PROFESSIONALS, INC
Entity type:Organization
Organization Name:CHICAGOLAND INTEGRATED PROFESSIONALS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:USHMA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-553-5936
Mailing Address - Street 1:534 PLAINFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5342
Mailing Address - Country:US
Mailing Address - Phone:217-553-5766
Mailing Address - Fax:877-870-9357
Practice Address - Street 1:1132 MANCHESTER AVE
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-2723
Practice Address - Country:US
Practice Address - Phone:219-934-5300
Practice Address - Fax:219-934-5389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-24
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty