Provider Demographics
NPI:1861591711
Name:CHATRATH, SANJAY (DO)
Entity type:Individual
Prefix:DR
First Name:SANJAY
Middle Name:
Last Name:CHATRATH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 S FIRST ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60481-8973
Mailing Address - Country:US
Mailing Address - Phone:815-476-5210
Mailing Address - Fax:815-476-4193
Practice Address - Street 1:105 S FIRST ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:IL
Practice Address - Zip Code:60481-8973
Practice Address - Country:US
Practice Address - Phone:815-476-5210
Practice Address - Fax:815-476-4193
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036089372207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036089372Medicaid
IL4632039OtherBC GROUP #
ILL34473Medicare PIN
ILF46004Medicare UPIN
IL36089372Medicaid
IL4632039OtherBC GROUP #