Provider Demographics
NPI:1700941176
Name:MUKHERJEE, AMAL K (MD)
Entity Type:Individual
Prefix:DR
First Name:AMAL
Middle Name:K
Last Name:MUKHERJEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1409 BURR OAK RD APT 102A
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-2997
Mailing Address - Country:US
Mailing Address - Phone:773-583-5558
Mailing Address - Fax:773-583-0221
Practice Address - Street 1:4101 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-2813
Practice Address - Country:US
Practice Address - Phone:773-583-5558
Practice Address - Fax:773-583-0221
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
C42002Medicare UPIN
477460Medicare ID - Type Unspecified