Basic Information
Provider Information
NPI: 1528137411
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHAWLA
FirstName: SAURABH
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 120 W 22ND ST STE 200
Address2:  
City: OAK BROOK
State: IL
PostalCode: 605231563
CountryCode: US
TelephoneNumber: 6305755000
FaxNumber:  
Practice Location
Address1: 6061 BROADWAY
Address2:  
City: MERRILLVILLE
State: IN
PostalCode: 464102619
CountryCode: US
TelephoneNumber: 2198842011
FaxNumber: 2198842810
Other Information
ProviderEnumerationDate: 11/07/2006
LastUpdateDate: 06/01/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/01/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RN0300X036116104ILN Allopathic & Osteopathic PhysiciansInternal MedicineNephrology
207RN0300X01081943AINY Allopathic & Osteopathic PhysiciansInternal MedicineNephrology

No ID Information.


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