Individual
DR. DATTA SAMBARE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5650 W MADISON ST, CHICAGO, IL 60644-3939
(773) 379-2304
Mailing address
PO BOX 215, WESTMONT, IL 60559-0215
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036094741
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036094741
—
IL
01
—
K11005
MEDICARE PIN - BROOKVILLE MEDICAL CENTER
IL
01
—
K11006
MEDICARE PIN - MADISON PARKSIDE MEDICAL CENTER
IL
Enumeration date
06/15/2006
Last updated
12/27/2016
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