Basic Information
Provider Information
NPI: 1720240179
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHOWDHURY
FirstName: SARA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2151 WAUKEGAN RD STE 140
Address2:  
City: BANNOCKBURN
State: IL
PostalCode: 600151868
CountryCode: US
TelephoneNumber: 8475702040
FaxNumber: 8477335315
Practice Location
Address1: 2151 WAUKEGAN RD STE 140
Address2:  
City: BANNOCKBURN
State: IL
PostalCode: 600151868
CountryCode: US
TelephoneNumber: 8476638540
FaxNumber: 8476631015
Other Information
ProviderEnumerationDate: 06/26/2008
LastUpdateDate: 03/24/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/24/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RE0101X036132340ILY Allopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism

No ID Information.


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