Basic Information
| Provider Information | |||||||||
| NPI: | 1972667624 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DHOLAKIA | ||||||||
| FirstName: | CHIRAG | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 745 FLETCHER DR | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | ELGIN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601234750 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476956600 | ||||||||
| FaxNumber: | 8476954279 | ||||||||
| Practice Location | |||||||||
| Address1: | 745 FLETCHER DR | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | ELGIN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601234750 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476956600 | ||||||||
| FaxNumber: | 8476954279 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2006 | ||||||||
| LastUpdateDate: | 12/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 1885 | WI | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 036126478 | IL | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 036126478 | 05 | IL | MEDICAID |