Basic Information
| Provider Information | |||||||||
| NPI: | 1114198223 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHHANGANI | ||||||||
| FirstName: | BANTU | ||||||||
| MiddleName: | SAMRIDHI | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 205 OAK TREE CT | ||||||||
| Address2: | |||||||||
| City: | PALOS PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604641978 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084081101 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1500 S LAKE PARK AVE | ||||||||
| Address2: | |||||||||
| City: | HOBART | ||||||||
| State: | IN | ||||||||
| PostalCode: | 46342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2199420551 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2008 | ||||||||
| LastUpdateDate: | 12/04/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 01070080A | IN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 4301081132 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RS0012X | 4301081132 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | 2084S0012X | 4301081132 | MI | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Sleep Medicine | 207RS0012X | 01070080A | IN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1114198223 | 05 | MI | MEDICAID |