Individual
CHANDRASHEKHAR THUKRAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
401 ROXBURY RD, ROCKFORD, IL 61107-5075
(815) 397-7340
(815) 397-7388
Mailing address
401 ROXBURY RD, ROCKFORD, IL 61107-5075
(815) 397-7340
(815) 397-7388
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
217223
MA
207RG0100X
Gastroenterology Physician
217223
MA
207RG0100X
Gastroenterology Physician
Primary
36117730
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
K39310
PTAN
IL
Enumeration date
04/10/2006
Last updated
01/30/2012
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