Organization
CARBONDALE FAMILY MEDICINE,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MUKESH CHAUDHRY M.D. (MD)
(618) 549-0300
Entity
Organization
Contact information
Practice address
1175 CEDAR CT, CARBONDALE, IL 62901-5333
(618) 549-0300
Mailing address
190 HIGH FOREST DR, CARBONDALE, IL 62903-8245
(618) 549-0300
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036-107111
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036-107111
—
IL
Enumeration date
12/28/2006
Last updated
01/11/2011
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