Provider Demographics
NPI:1366539264
Name:CHHABLANI, ASHA (MD)
Entity type:Individual
Prefix:
First Name:ASHA
Middle Name:
Last Name:CHHABLANI
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 1:2800 SOUTH ELLIS AVENUE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2907
Mailing Address - Country:US
Mailing Address - Phone:312-791-2681
Mailing Address - Fax:312-791-2691
Practice Address - Street 1:2800 SOUTH VERNON AVENUE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2907
Practice Address - Country:US
Practice Address - Phone:312-791-2681
Practice Address - Fax:312-791-2691
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001616079OtherBLUE CROSS
IL603910Medicare ID - Type Unspecified
IL0001616079OtherBLUE CROSS