Provider Demographics
NPI:1063404580
Name:CHANDARANA, KANTILAL (MD)
Entity type:Individual
Prefix:DR
First Name:KANTILAL
Middle Name:
Last Name:CHANDARANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21540 W EMPRESS LN
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-6316
Mailing Address - Country:US
Mailing Address - Phone:708-246-2468
Mailing Address - Fax:708-887-5532
Practice Address - Street 1:21540 W EMPRESS LN
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-6316
Practice Address - Country:US
Practice Address - Phone:708-246-2468
Practice Address - Fax:708-887-5532
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360447432085R0202X
IL360447432085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00228611OtherRAILROAD MEDICARE PIN
IL036044743Medicaid
IL36044743OtherSTATE OF ILLINOIS LICENSE
IL740210OtherMEDICARE LEGACY NUMBER
IL740210OtherMEDICARE LEGACY NUMBER
ILP08546Medicare PIN
ILP08546Medicare PIN