Chandran, Nisha

Chandran, Nisha is an individual health care provider with primary practice located at 621 Roxbury Rd , Rockford IL 61107-5077. She recently has 2 registered licenses in different health care specialties including Student, Health Care / Student in an Organized Health Care Education/Training Program, Allopathic & Osteopathic Physicians / Pediatrics. Allopathic & Osteopathic Physicians / Pediatrics is her primary health care specialty. Chandran, Nisha can be contacted via phone (815) 397-3350.

Contact Information

Primary practice address
621 Roxbury Rd Rockford IL 61107-5077
Phone: (815) 397-3350
Fax: (815) 227-2992
Website:
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Health care specialties

SpecialtyCodeLicense #State
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X 036114562 Illinois
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 036114562 Illinois

Profile Details

NPI number 1649299967
LBN Legal business name Chandran, Nisha
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 18th, 2006
Last updated May 2nd, 2012 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1649299967 NPPES
Illinois Other 05632081 BLUE CROSS BLUE SHIELD
Illinois MEDICAID 036114562 BLUE CROSS BLUE SHIELD
Illinois Other 07100059 BLUE CROSS BLUE SHIELD

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