# CARBONDALE FAMILY MEDICINE,LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518023530
- **Authorized official:** DR. MUKESH CHAUDHRY M.D. (MD)
- **Authorized official phone:** (618) 549-0300

## Contact information

- **Practice address:** 1175 CEDAR CT, CARBONDALE, IL 62901-5333
- **Practice address phone:** (618) 549-0300
- **Mailing address:** 190 HIGH FOREST DR, CARBONDALE, IL 62903-8245
- **Mailing address phone:** (618) 549-0300

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 036-107111 | IL | Yes |

## Other

- **Enumeration date:** 12/28/2006
- **Last updated:** 01/11/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 036-107111 | — | IL |