Provider Demographics
NPI:1811094550
Name:CHANDAN, NARESH C (DO)
Entity type:Individual
Prefix:DR
First Name:NARESH
Middle Name:C
Last Name:CHANDAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 N WALL ST STE 102
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-2934
Mailing Address - Country:US
Mailing Address - Phone:815-928-5090
Mailing Address - Fax:815-928-5079
Practice Address - Street 1:401 N WALL ST STE 102
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901
Practice Address - Country:US
Practice Address - Phone:815-928-5090
Practice Address - Fax:815-928-5079
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036090440207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4632039OtherBC GROUP NUMBER
IL36090440Medicaid
ILL58648Medicare PIN
IL356253Medicare ID - Type UnspecifiedMEDICARE GROUP #
IL363167726Medicare ID - Type UnspecifiedMEDICARE TAX ID #
IL4632039OtherBC GROUP NUMBER