Provider Demographics
NPI:1801258322
Name:CHAND, MUMTAJ (DO)
Entity type:Individual
Prefix:
First Name:MUMTAJ
Middle Name:
Last Name:CHAND
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7447 W TALCOTT AVE STE 467
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3715
Mailing Address - Country:US
Mailing Address - Phone:773-763-1126
Mailing Address - Fax:
Practice Address - Street 1:7447 W TALCOTT AVE STE 467
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3715
Practice Address - Country:US
Practice Address - Phone:773-763-1126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-23
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.148793208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics