Provider Demographics
NPI:1720347032
Name:AMAL K. MUKHERJEE MD SC
Entity Type:Organization
Organization Name:AMAL K. MUKHERJEE MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMAL
Authorized Official - Middle Name:K
Authorized Official - Last Name:MUKHERJEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-525-6064
Mailing Address - Street 1:1409 BURR OAK RD
Mailing Address - Street 2:UNIT 102A
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:68521
Mailing Address - Country:US
Mailing Address - Phone:773-525-6064
Mailing Address - Fax:773-525-6067
Practice Address - Street 1:840 W IRVING PARK AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:68613
Practice Address - Country:US
Practice Address - Phone:773-525-6064
Practice Address - Fax:773-525-6064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-07
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036048011208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty