Provider Demographics
NPI:1811988520
Name:CHAILERBORISUTH, NAVANEET S (MD, PHD)
Entity type:Individual
Prefix:
First Name:NAVANEET
Middle Name:S
Last Name:CHAILERBORISUTH
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 30TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-7038
Mailing Address - Country:US
Mailing Address - Phone:309-788-5524
Mailing Address - Fax:309-788-9550
Practice Address - Street 1:4600 30TH ST
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-7038
Practice Address - Country:US
Practice Address - Phone:309-788-5524
Practice Address - Fax:309-788-9550
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA32999207W00000X
IL036-097565207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1525816Medicaid
IL036097565Medicaid
IL036097565Medicaid
IAI7380Medicare PIN
IL211867Medicare PIN