Provider Demographics
NPI:1215267786
Name:MEDICAL ASSOCIATES OF CHATAM, LTD
Entity type:Organization
Organization Name:MEDICAL ASSOCIATES OF CHATAM, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIJAYA
Authorized Official - Middle Name:K
Authorized Official - Last Name:SARMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-488-2595
Mailing Address - Street 1:8541 S STATE ST
Mailing Address - Street 2:SUITE #9
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-5665
Mailing Address - Country:US
Mailing Address - Phone:773-488-2595
Mailing Address - Fax:773-783-8561
Practice Address - Street 1:8541 S STATE ST
Practice Address - Street 2:SUITE #9
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-5665
Practice Address - Country:US
Practice Address - Phone:773-488-2595
Practice Address - Fax:773-783-8561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-06
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036099712261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036099712Medicaid
ILH01032OtherUPIN
IL204403Medicare PIN