Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 036-055782 | IL |
Y | 2080P0208X | Pediatric Infectious Diseases | 036-055782 | IL |
NPI | 1073597936 |
---|---|
Provider Name | Subhash C Chaudhary |
First Address | Springfield, IL 62794-9658 |
Second Address | Springfield, IL 62701-1013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2005 |
Last Update Date | 27/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036055782 | (05) | IL |
D15830 | (02) |