Individual
SHAKUNTALA CHHABRIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
222S GREENLEAF ST 111, GURNEE, IL 60031-5705
(847) 360-0044
(847) 360-8804
Mailing address
222 SOUTH GREENLEAF STREET SUITE 111, GURNEE, IL 60031-5705
(847) 587-6112
(847) 587-6113
Taxonomy
Speciality
Code
Description
License number
State
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
036053149
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036053149
—
IL
01
—
4900918
BLUE CROSS BLUE SHIELD
IL
01
—
P00275220
RAIL ROAD MEDICARE
IL
Enumeration date
01/16/2007
Last updated
07/23/2015
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