Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 36112433 | IL |
Y | 208D00000X | General Practice Physician | 36112433 | IL |
NPI | 1043343569 |
---|---|
Provider Name | Jogendra Singh Chhabra |
First Address | Marion, IL 62959-1573 |
Second Address | Norris City, IL 62869-0464 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2007 |
Last Update Date | 06/03/2012 |