Basic Information
| Provider Information | |||||||||
| NPI: | 1992856678 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHHABRIA | ||||||||
| FirstName: | SHAKUNTALA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 222 SOUTH GREENLEAF STREET SUITE 111 | ||||||||
| Address2: | |||||||||
| City: | GURNEE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600315705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475876112 | ||||||||
| FaxNumber: | 8475876113 | ||||||||
| Practice Location | |||||||||
| Address1: | 222S GREENLEAF ST 111 | ||||||||
| Address2: | |||||||||
| City: | GURNEE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600315705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8473600044 | ||||||||
| FaxNumber: | 8473608804 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2007 | ||||||||
| LastUpdateDate: | 07/23/2015 | ||||||||
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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 | 2084N0402X | 036053149 | IL | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology with Special Qualifications in Child Neurology |
ID Information
| ID | Type | State | Issuer | Description | 036053149 | 05 | IL | MEDICAID | P00275220 | 01 | IL | RAIL ROAD MEDICARE | OTHER | 4900918 | 01 | IL | BLUE CROSS BLUE SHIELD | OTHER |