Provider Demographics
NPI:1770761298
Name:INDIRARAJ, CHENNI CHETTY (MD)
Entity type:Individual
Prefix:
First Name:CHENNI
Middle Name:CHETTY
Last Name:INDIRARAJ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 CONCORD CT
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-3249
Mailing Address - Country:US
Mailing Address - Phone:630-968-0131
Mailing Address - Fax:
Practice Address - Street 1:1430 CONCORD CT
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516-3249
Practice Address - Country:US
Practice Address - Phone:630-968-0131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery