Provider Demographics
NPI:1366411423
Name:CHAUDHURI, SARMISTHA (MD)
Entity type:Individual
Prefix:
First Name:SARMISTHA
Middle Name:
Last Name:CHAUDHURI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 S FIRST AVE
Mailing Address - Street 2:BLDG 104 ROOM 5376
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153
Mailing Address - Country:US
Mailing Address - Phone:708-216-6705
Mailing Address - Fax:708-216-5884
Practice Address - Street 1:2160 S FIRST AVE
Practice Address - Street 2:BLDG 104 ROOM 5376
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153
Practice Address - Country:US
Practice Address - Phone:708-216-6705
Practice Address - Fax:708-216-5884
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036096998207X00000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036096998Medicaid
ILK14708Medicare ID - Type Unspecified
H28945Medicare UPIN
IL036096998Medicaid