Individual
NISHA CHANDRAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
621 ROXBURY RD, ROCKFORD, IL 61107-5077
(815) 397-3350
(815) 227-2992
Mailing address
621 ROXBURY RD, ROCKFORD, IL 61107-5077
(815) 397-3350
(815) 227-2992
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036114562
IL
390200000X
Student in an Organized Health Care Education/Training Program
036114562
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036114562
—
IL
01
—
05632081
BLUE CROSS BLUE SHIELD
IL
01
—
07100059
IL HEALTH CONNECT
IL
Enumeration date
07/18/2006
Last updated
05/02/2012
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